Leung Viviena, Avnet Hagai, Henry Amanda, Wang Jingjing, Redmond Stephen, Welsh Alec W
School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia.
Fetal Diagn Ther. 2018;44(1):28-35. doi: 10.1159/000478928. Epub 2017 Sep 27.
To compare the repeatability and degree of absolute agreement of an automated fetal right myocardial performance index (MPI) algorithm with manual measurements along with the impact of MPI observer experience on these two aspects.
Prospective cross-sectional study of 65 uncomplicated singleton pregnancies from 22 to 39 weeks' gestation. Image analysis of double-waveform right MPI measurements was conducted first with a MATLAB automated MPI software and then independently by an experienced and an inexperienced observer. Intraclass correlation coefficients (ICCs) and 95% confidence intervals (95% CI) were used to evaluate manual and automated intra- and interobserver repeatability. In addition, Bland-Altman plots were used to determine the degree of absolute agreement.
Successful automation was performed on 63 cases (97%) showing repeatability ICCs of: 0.83 manual intraobserver; 0.77 manual interobserver; 1.00 automated. The degree of absolute agreement between manual and automated values was: inexperienced observer ICC 0.43 (95% CI 0.21-0.62); experienced observer ICC 0.76 (95% CI 0.63-0.85).
Automation of right MPI demonstrates a superior reproducibility over manual measurements and reduces the experience required for successful analysis. This may lend a greater clinical applicability to MPI, and future studies to develop an automated universal reference range would be useful.
比较自动化胎儿右心室心肌做功指数（MPI）算法与手动测量的重复性和绝对一致性程度，以及MPI观察者经验对这两个方面的影响。
对65例妊娠22至39周的单胎无并发症妊娠进行前瞻性横断面研究。首先使用MATLAB自动化MPI软件对双波形右心室MPI测量进行图像分析，然后由一名经验丰富的观察者和一名经验不足的观察者独立进行分析。组内相关系数（ICC）和95%置信区间（95%CI）用于评估手动和自动化测量的观察者内和观察者间重复性。此外，使用Bland-Altman图确定绝对一致性程度。
63例（97%）成功实现自动化，显示出以下重复性ICC值：手动测量观察者内为0.83；手动测量观察者间为0.77；自动化测量为1.00。手动和自动化测量值之间的绝对一致性程度为：经验不足的观察者ICC为0.43（95%CI 0.21-0.62）；经验丰富的观察者ICC为0.76（95%CI 0.63-0.85）。
右心室MPI自动化显示出比手动测量更好的可重复性，并减少了成功分析所需的经验。这可能使MPI具有更大的临床适用性，未来开展开发自动化通用参考范围的研究将很有帮助。
