In vivo accuracy of two radiographic systems in the detection of Bjork- Shiley convexo-concave heart valve outlet strut single leg separations

K. D. Hopper, Ian Gilchrist, J. R. Landis, A. H. Abolfathi, A. R. Localio, Ronald Wilson, Walter Pae, Allen Kunselman, D. W. Wieting, J. W. Griffith, W. S. Pierce, P. S. Potok, T. R. TenHave, J. G. Chandler, G. L. Grunkemeier

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Objective: Modified cineradiographic systems have been used clinically to detect partially broken outlet struts in normally functioning Bjork- Shiley convexo-concave heart valves. Almost all such valves were explanted, presuming that full failure would likely follow. Inasmuch as the clinical setting only rarely permits examination of normally rated valves, the accuracy of radiographic detection cannot be clinically defined. This study uses the clinical radiographic technique in sheep implanted with known- status convexo-concave valves, comparing its accuracy and that of a newly developed, geometric image magnification radiography system. Methods: Twenty- one sheep with mitral convexo-concave valves were studied on both systems. Five were used for extensive training. When operators were expert with both systems, images of four intact valves and 12 valves with outlet strut single leg separations, along with a seventeenth single leg separation valve used for calibration, were integrated into 112 image sets organized into a balanced incomplete block design for evaluation by eight trained, blinded reviewers. Results: Cineradiography sensitivity was 24% versus 31% for direct image magnification. The odds ratio for detection of single leg separation by direct image magnification versus cineradiography was 2.0 (95% confidence interval, 0.76 to 5.9; p = 0.13). Cineradiography specificity was 93% versus 90% for direct image magnification. Sensitivity and specificity varied markedly by reviewer, with sensitivity ranging from 8% to 55% and specificity from 51% to 100% for the combined technologies. Conclusions: The data support the need for more intensive training for convexo-concave valve imaging and further investigation of unconventional radiographic technologies. Clinical cineradiography of convexo-concave valves may detect as little as 25% of valves having a single leg separation, underestimating the prevalence of single leg separations and thereby implying more rapid progression to full fracture than is actually the case.

Original languageEnglish (US)
Pages (from-to)582-590
Number of pages9
JournalJournal of Thoracic and Cardiovascular Surgery
Volume115
Issue number3
DOIs
StatePublished - Jan 1 1998

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Cineradiography
Heart Valves
Leg
Sheep
Technology
Radiography
Calibration
Odds Ratio
Confidence Intervals
Sensitivity and Specificity

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Hopper, K. D. ; Gilchrist, Ian ; Landis, J. R. ; Abolfathi, A. H. ; Localio, A. R. ; Wilson, Ronald ; Pae, Walter ; Kunselman, Allen ; Wieting, D. W. ; Griffith, J. W. ; Pierce, W. S. ; Potok, P. S. ; TenHave, T. R. ; Chandler, J. G. ; Grunkemeier, G. L. / In vivo accuracy of two radiographic systems in the detection of Bjork- Shiley convexo-concave heart valve outlet strut single leg separations. In: Journal of Thoracic and Cardiovascular Surgery. 1998 ; Vol. 115, No. 3. pp. 582-590.
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title = "In vivo accuracy of two radiographic systems in the detection of Bjork- Shiley convexo-concave heart valve outlet strut single leg separations",
abstract = "Objective: Modified cineradiographic systems have been used clinically to detect partially broken outlet struts in normally functioning Bjork- Shiley convexo-concave heart valves. Almost all such valves were explanted, presuming that full failure would likely follow. Inasmuch as the clinical setting only rarely permits examination of normally rated valves, the accuracy of radiographic detection cannot be clinically defined. This study uses the clinical radiographic technique in sheep implanted with known- status convexo-concave valves, comparing its accuracy and that of a newly developed, geometric image magnification radiography system. Methods: Twenty- one sheep with mitral convexo-concave valves were studied on both systems. Five were used for extensive training. When operators were expert with both systems, images of four intact valves and 12 valves with outlet strut single leg separations, along with a seventeenth single leg separation valve used for calibration, were integrated into 112 image sets organized into a balanced incomplete block design for evaluation by eight trained, blinded reviewers. Results: Cineradiography sensitivity was 24{\%} versus 31{\%} for direct image magnification. The odds ratio for detection of single leg separation by direct image magnification versus cineradiography was 2.0 (95{\%} confidence interval, 0.76 to 5.9; p = 0.13). Cineradiography specificity was 93{\%} versus 90{\%} for direct image magnification. Sensitivity and specificity varied markedly by reviewer, with sensitivity ranging from 8{\%} to 55{\%} and specificity from 51{\%} to 100{\%} for the combined technologies. Conclusions: The data support the need for more intensive training for convexo-concave valve imaging and further investigation of unconventional radiographic technologies. Clinical cineradiography of convexo-concave valves may detect as little as 25{\%} of valves having a single leg separation, underestimating the prevalence of single leg separations and thereby implying more rapid progression to full fracture than is actually the case.",
author = "Hopper, {K. D.} and Ian Gilchrist and Landis, {J. R.} and Abolfathi, {A. H.} and Localio, {A. R.} and Ronald Wilson and Walter Pae and Allen Kunselman and Wieting, {D. W.} and Griffith, {J. W.} and Pierce, {W. S.} and Potok, {P. S.} and TenHave, {T. R.} and Chandler, {J. G.} and Grunkemeier, {G. L.}",
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Hopper, KD, Gilchrist, I, Landis, JR, Abolfathi, AH, Localio, AR, Wilson, R, Pae, W, Kunselman, A, Wieting, DW, Griffith, JW, Pierce, WS, Potok, PS, TenHave, TR, Chandler, JG & Grunkemeier, GL 1998, 'In vivo accuracy of two radiographic systems in the detection of Bjork- Shiley convexo-concave heart valve outlet strut single leg separations', Journal of Thoracic and Cardiovascular Surgery, vol. 115, no. 3, pp. 582-590. https://doi.org/10.1016/S0022-5223(98)70322-8

In vivo accuracy of two radiographic systems in the detection of Bjork- Shiley convexo-concave heart valve outlet strut single leg separations. / Hopper, K. D.; Gilchrist, Ian; Landis, J. R.; Abolfathi, A. H.; Localio, A. R.; Wilson, Ronald; Pae, Walter; Kunselman, Allen; Wieting, D. W.; Griffith, J. W.; Pierce, W. S.; Potok, P. S.; TenHave, T. R.; Chandler, J. G.; Grunkemeier, G. L.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 115, No. 3, 01.01.1998, p. 582-590.

Research output: Contribution to journalArticle

TY - JOUR

T1 - In vivo accuracy of two radiographic systems in the detection of Bjork- Shiley convexo-concave heart valve outlet strut single leg separations

AU - Hopper, K. D.

AU - Gilchrist, Ian

AU - Landis, J. R.

AU - Abolfathi, A. H.

AU - Localio, A. R.

AU - Wilson, Ronald

AU - Pae, Walter

AU - Kunselman, Allen

AU - Wieting, D. W.

AU - Griffith, J. W.

AU - Pierce, W. S.

AU - Potok, P. S.

AU - TenHave, T. R.

AU - Chandler, J. G.

AU - Grunkemeier, G. L.

PY - 1998/1/1

Y1 - 1998/1/1

N2 - Objective: Modified cineradiographic systems have been used clinically to detect partially broken outlet struts in normally functioning Bjork- Shiley convexo-concave heart valves. Almost all such valves were explanted, presuming that full failure would likely follow. Inasmuch as the clinical setting only rarely permits examination of normally rated valves, the accuracy of radiographic detection cannot be clinically defined. This study uses the clinical radiographic technique in sheep implanted with known- status convexo-concave valves, comparing its accuracy and that of a newly developed, geometric image magnification radiography system. Methods: Twenty- one sheep with mitral convexo-concave valves were studied on both systems. Five were used for extensive training. When operators were expert with both systems, images of four intact valves and 12 valves with outlet strut single leg separations, along with a seventeenth single leg separation valve used for calibration, were integrated into 112 image sets organized into a balanced incomplete block design for evaluation by eight trained, blinded reviewers. Results: Cineradiography sensitivity was 24% versus 31% for direct image magnification. The odds ratio for detection of single leg separation by direct image magnification versus cineradiography was 2.0 (95% confidence interval, 0.76 to 5.9; p = 0.13). Cineradiography specificity was 93% versus 90% for direct image magnification. Sensitivity and specificity varied markedly by reviewer, with sensitivity ranging from 8% to 55% and specificity from 51% to 100% for the combined technologies. Conclusions: The data support the need for more intensive training for convexo-concave valve imaging and further investigation of unconventional radiographic technologies. Clinical cineradiography of convexo-concave valves may detect as little as 25% of valves having a single leg separation, underestimating the prevalence of single leg separations and thereby implying more rapid progression to full fracture than is actually the case.

AB - Objective: Modified cineradiographic systems have been used clinically to detect partially broken outlet struts in normally functioning Bjork- Shiley convexo-concave heart valves. Almost all such valves were explanted, presuming that full failure would likely follow. Inasmuch as the clinical setting only rarely permits examination of normally rated valves, the accuracy of radiographic detection cannot be clinically defined. This study uses the clinical radiographic technique in sheep implanted with known- status convexo-concave valves, comparing its accuracy and that of a newly developed, geometric image magnification radiography system. Methods: Twenty- one sheep with mitral convexo-concave valves were studied on both systems. Five were used for extensive training. When operators were expert with both systems, images of four intact valves and 12 valves with outlet strut single leg separations, along with a seventeenth single leg separation valve used for calibration, were integrated into 112 image sets organized into a balanced incomplete block design for evaluation by eight trained, blinded reviewers. Results: Cineradiography sensitivity was 24% versus 31% for direct image magnification. The odds ratio for detection of single leg separation by direct image magnification versus cineradiography was 2.0 (95% confidence interval, 0.76 to 5.9; p = 0.13). Cineradiography specificity was 93% versus 90% for direct image magnification. Sensitivity and specificity varied markedly by reviewer, with sensitivity ranging from 8% to 55% and specificity from 51% to 100% for the combined technologies. Conclusions: The data support the need for more intensive training for convexo-concave valve imaging and further investigation of unconventional radiographic technologies. Clinical cineradiography of convexo-concave valves may detect as little as 25% of valves having a single leg separation, underestimating the prevalence of single leg separations and thereby implying more rapid progression to full fracture than is actually the case.

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