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Research ArticleImaging

Reliability of a Scoring System for Qualitative Evaluation of Lymphoscintigraphy of the Lower Extremities

Mojgan Ebrahim, Irina Savitcheva and Rimma Axelsson
Journal of Nuclear Medicine Technology September 2017, 45 (3) 219-224; DOI: https://doi.org/10.2967/jnmt.116.185710
Mojgan Ebrahim
1Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Solna, Sweden; and
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Irina Savitcheva
1Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Solna, Sweden; and
2Division of Function and Imaging, Department of Medical Physics and Nuclear Medicine, Karolinska University Hospital, Huddinge, Sweden
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Rimma Axelsson
1Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Solna, Sweden; and
2Division of Function and Imaging, Department of Medical Physics and Nuclear Medicine, Karolinska University Hospital, Huddinge, Sweden
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Figures

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  • FIGURE 1.
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    FIGURE 1.

    Percentage of lymphoscintigrams in 4 different groups of MTS.

  • FIGURE 2.
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    FIGURE 2.

    Histogram of DTS between observers at scoring time 1. Data are absolute values of DTS.

  • FIGURE 3.
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    FIGURE 3.

    Histogram of DTS between observers at scoring time 2. Data are absolute values of DTS.

  • FIGURE 4.
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    FIGURE 4.

    Histogram of DTS between scoring times for observer 1. Data are absolute values of DTS.

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    FIGURE 5.

    Histogram of DTS between scoring times for observer 2. Data are absolute values of DTS.

Tables

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    TABLE 1

    The Scoring System

    CriterionCategoryOptionsScore
    C1Display of lymphatic vesselsVisible entirely (extending to pelvis)0
    Visible partially3
    Not visible10
    C2Pattern of lymphatic vesselsStraight with ordinary course0
    Straight with abnormal course3
    Tortuous/prominent with some points of ordinary course3
    Tortuous/prominent with some points of abnormal course5
    C3Uptake in inguinal nodesUptake before stress0
    Uptake after stress1
    No uptake at third hour10
    C4Uptake in pelvic nodesUptake0
    No uptake5
    C5Uptake in lumbar nodesUptake0
    No uptake5
    C6Uptake in leg nodes outside vessel: foot, knee, lower leg, thighNo uptake0
    Uptake3
    C7Focal accumulationNo focal accumulation0
    Focal accumulation, increasing with time10
    C8Dermal backflowNo dermal backflow0
    Dermal backflow10
    • View popup
    TABLE 2

    Scores for Each Observer

    Observer 1Observer 2
    CriterionScoring time 1Scoring time 2Scoring time 1Scoring time 2
    C10.72 ± 2.360.88 ± 2.580.95 ± 2.510.85 ± 2.65
    C20.71 ± 1.360.79 ± 1.42*0.57 ± 1.230.59 ± 1.29*
    C30.53 ± 1.580.56 ± 1.580.67 ± 1.890.65 ± 1.74
    C40.34 ± 1.260.31 ± 1.210.31 ± 1.210.22 ± 1.02
    C50.78 ± 1.820.68 ± 1.720.83 ± 1.870.77 ± 1.81
    C60.37 ± 0.990.42 ± 1.030.40 ± 1.010.39 ± 1.01
    C71.11 ± 3.15†0.74 ± 2.630.43 ± 2.04†0.43 ± 2.04
    C80.80 ± 2.721.04 ± 3.070.86 ± 2.820.99 ± 2.99
    Total score5.37 ± 8.495.43 ± 8.455.02 ± 7.894.88 ± 8.11
    • ↵* Significant difference between observers at scoring time 2.

    • ↵† Significant difference between observers at scoring time 1.

    • Data are mean ± SD.

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    TABLE 3

    Interobserver Reliability

    Scoring time 1Scoring time 2
    CriterionAgreementκAgreementκ
    C190.7%0.635 (0.559–0.711)90.7%0.596 (0.518–0.647)
    C282.7%0.490 (0.418–0.562)83.3%0.526 (0.448–0.604)
    C390.1%0.782 (0.718–0.849)88.9%0.767 (0.703–0.831)
    C499.4%0.949 (0.899–1.00)98.1%0.814 (0.710–0.918)
    C593.8%0.790 (0.723–0.857)96.9%0.876 (0.822–0.930)
    C692.6%0.673 (0.610–0.736)92.0%0.668 (0.608–0.728)
    C792.0%0.448 (0.383–0.513)93.2%0.411 (0.347–0.475)
    C895.7%0.719 (0.658–0.780)91.9%0.560 (0.504–0.616)
    • Data in parentheses are 95% CI.

    • View popup
    TABLE 4

    Intraobserver Reliability

    Observer 1Observer 2
    CriterionAgreementκAgreementκ
    C195.1%0.781 (0.712–0.850)85.8%0.458 (0.413–0.503)
    C284.6%0.606 (0.534–0.678)85.7%0.543 (0.505–0.581)
    C391.4%0.809 (0.744–0.874)88.3%0.519 (0.464–0.574)
    C499.4%0.949 (0.899–1.00)98.1%0.814 (0.710–0.918)
    C597.5%0.925 (0.882–0.968)96.3%0.863 (0.808–0.918)
    C691.4%0.637 (0.583–0.691)95.1%0,823 (0.756–0.890)
    C793.8%0.633 (0.558–0.708)95.1%0.410 (0.331–0.489)
    C893.8%0.659 (0.584–0.734)97.5%0.839 (0.758–0.920)
    • Data in parentheses are 95% CI.

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Journal of Nuclear Medicine Technology: 45 (3)
Journal of Nuclear Medicine Technology
Vol. 45, Issue 3
September 1, 2017
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Reliability of a Scoring System for Qualitative Evaluation of Lymphoscintigraphy of the Lower Extremities
Mojgan Ebrahim, Irina Savitcheva, Rimma Axelsson
Journal of Nuclear Medicine Technology Sep 2017, 45 (3) 219-224; DOI: 10.2967/jnmt.116.185710

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Reliability of a Scoring System for Qualitative Evaluation of Lymphoscintigraphy of the Lower Extremities
Mojgan Ebrahim, Irina Savitcheva, Rimma Axelsson
Journal of Nuclear Medicine Technology Sep 2017, 45 (3) 219-224; DOI: 10.2967/jnmt.116.185710
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