CT肺动脉成像诊断肺栓塞的一致性研究

Interobserver agreement between six radiologists with different level of expertise in the diagnosis of pulmonary embolism using CTPA

目的评价CT肺动脉成像(CTPA)诊断肺栓塞(PE)时,不同经验的读片者间和同一读片者内的一致性。方法 55例临床可疑PE患者行CTPA检查,6位不同经验的放射科医生独立地分析CTPA图像来评价读片者间的一致性。3位放射科医生3个月后第二次分析CTPA图像来评价读片者内的一致性。PE的表现分为阳性、阴性和难以确定。读片者一致性用百分比及Kappa系数表示。结果 6位读片者判定29～31例(平均29.2例)患者CTPA为PE阳性,1～5例(平均3.0例)患者CTPA为难以确定。6位读片者在48例(87.3%)患者CTPA的诊断上取得一致意见,5位读片者在4例患者(7.3%)的诊断上取得一致意见,4位读片者在2例患者(3.6%)的诊断上取得一致意见,3位读片者在1例患者(1.8%)的诊断上取得一致意见。在诊断PE上,如果以每例患者为观察单位,读片者间的一致性"非常好"(Kappa值为0.91)。以每个肺动脉为观察单位,读片者间的一致性"好"(85%,Kappa值为0.74);以肺叶动脉为观察单位,读片者间的一致性"好"(89%,Kappa值为0.78);以肺段动脉为观察单位,读片者间的一致性"中等"(75%,Kappa值为0.59)。如果以每例患者为观察单位,同一读片者内的平均一致性"非常好"(96%,Kappa值为0.93)。结论在CTPA上诊断PE时,经验不同的读片者间和同一读片者内的一致性均较好。

Objective To evaluate the interobserver agreement between six radiologists with different level of expertise in the diagnosis of pulmonary embolism（PE） using computed tomography pulmonary angiography（CTPA）.Methods Fifty-five patients with clinically suspected PE underwent CTPA.The imaging data of all patients were blindly and independently evaluated by six radiologists for understanding the interobserver agreement and three months later were secondarily evaluated by three radiologists of them for understanding the intraobserver agreement.Agreement was evaluated by percentage and means of the Kappa test.Results On CTPA images,29-31（mean 29.2） cases with positive PE and 1-5（mean 3.0） cases with undetermined PE were identified by six radiologists.Six radiologists in diagnosing 48（87.3%） cases were agreement,five radiologists in 4（7.3%） cases were agreement,four radiologists in 2（3.6%） cases were agreement and three radiologists in 1（1.8%） case was agreement.The interobserver agreement at each patient as the indicator was excellent（kappa value 0.91）,at each pulmonary artery as the indicator was well（85%,kappa value 0.74）,at each lobar artery as the indicator was well（89%,kappa value 0.78）,at each segmental artery as the indicator was middle（75%,kappa value 0.59）,while the intraobserver agreement at each patient as the indicator was excellent（96%,kappa value 0.93）.Conclusion In the diagnosis of PE with CTPA,either interobserver agreement from different level radiologists or intraobserver agreement from identical reader are well.