Conventional MRI combined with DTI for neonatal hyperbilirubinemia; Methodological issues on diagnostic value
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Bibliographic record
Abstract
We read with interest the article by Yan R and colleagues published in the April 2018 issue of Pediatr Neonatol.1Yan R. Han D. Ren J. Zhai Z. Zhou F. Cheng J. Diagnostic value of conventional MRI combined with DTI for neonatal hyperbilirubinemia.Pediatr Neonatol. 2018; 59: 161-167Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar Increased signal intensity in the globus pallidus on MR T1WI is an important sign of neonatal bilirubin encephalopathy. Brain diffusion tensor imaging (DTI) has not been used extensively to study hyperbilirubinemia (HB). The purpose of the authors was to evaluate the diagnostic value of conventional magnetic resonance imaging (MRI) combined with DTI (MRI-DTI) in neonatal hyperbilirubinemia.1Yan R. Han D. Ren J. Zhai Z. Zhou F. Cheng J. Diagnostic value of conventional MRI combined with DTI for neonatal hyperbilirubinemia.Pediatr Neonatol. 2018; 59: 161-167Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar A total of 73 newborns with hyperbilirubinemia were grouped as follows: the mild increase group (M, 27 cases), the moderate increase group (O, 28 cases), and the severe group (S, 18 cases). The authors performed cranial MRI in these newborns, as well as in 29 full-term healthy infants (group N). They assessed the relationships among the signal from the globus pallidus, fractional anisotropy (FA), and average diffusion coefficient (DCav) of the posterior limb of the internal capsule (PLIC). Their results showed significant differences in the mean signal value of bilateral globus pallidus between group O/S and group N [p = 0.02 and 0.001 (left), 0.03 and 0.001 (right)]. There were no significant differences in bilateral FA or DCav values between the patient groups and group N. The bilateral PLIC-FA and DCav values were significantly different between the patient groups and group N (P = 0.01 and 0.04, respectively). Despite these interesting results, some methodological issues should be noted. Diagnostic value can be considered as diagnostic accuracy (validity) and diagnostic precision (reliability). To assess validity for qualitative variables, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio and negative likelihood ratio, and diagnostic accuracy and odds ratio (ratio of true to false results) are among the most appropriate tests. However, for clinical purposes, it is important to understand that reporting the diagnostic added value of a diagnostic test using receiver operating characteristic (ROC) curve should be considered. Furthermore, it is important to understand that internal validity as well as external validity of a diagnostic model should also be assessed.2Szklo M. Nieto F.J. Epidemiology beyond the basics.3rd ed. Jones and Bartlett Publisher, Manhattan, new York, United State2014Google Scholar Reliability (precision) as a different methodological issue of diagnostic value should be evaluated using appropriate tests. For qualitative variables, weighted kappa should be applied.2Szklo M. Nieto F.J. Epidemiology beyond the basics.3rd ed. Jones and Bartlett Publisher, Manhattan, new York, United State2014Google Scholar, 3Sabour S. Validity and reliability of the new Canadian Nutrition Screening Tool in the ‘real-world’ hospital setting: methodological issues.Eur J Clin Nutr. 2015; 69: 864Crossref PubMed Scopus (43) Google Scholar, 4Sabour S. Reliability assurance of EML4-ALK rearrangement detection in non-small cell lung cancer: a methodological and statistical issue.J Thorac Oncol. 2016; 11: e92-e93Abstract Full Text Full Text PDF PubMed Scopus (42) Google Scholar, 5Sabour S. Adherence to guidelines strongly improves reproducibility of brachial artery flow-mediated dilation. Common mistakes and methodological issue.Atherosclerosis. 2016; 251: 490-491Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar The authors concluded that increased signal intensity in the globus pallidus on T1-weighted imaging can be used as an objective index to evaluate neonatal bilirubin encephalopathy. Such a conclusion should be supported by the abovementioned statistical and methodological issues. The author has no conflicts of interest relevant to this article. The following is the supplementary data related to this article: Download .xml (.0 MB) Help with xml files Multimedia component 1
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.157 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.004 | 0.003 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it