腹盆区磁共振成像检查骨骼异常信号漏报漏诊调查与分析

Investigation and analysis on misdiagnosis of abnormal skeletal signal in routine MRI examination for abdominal and pelvic region

目的:研究腹盆区磁共振成像(MRI)检查时骨骼异常信号的漏报漏诊现象及成因。方法:收集95例行腹盆区MRI及X射线计算机断层扫描(CT)检查的住院患者,筛出MRI报告中未提及骨骼异常信号的案例,组织3位高年资医师再次研读图像,对其中的MRI骨骼异常信号作性质和类型进行分析,并查找漏报漏诊原因。结果:在95例MRI骨骼阴性报告中有43例患者(占45.2%)漏报71个骨骼异常信号,包括9种性质(含3例疑似转移瘤,16例脂质沉积,10例骨质增生,7例吸收囊变,6例许莫氏结节,2例骨岛,1例椎体压缩,1例终板炎,3例难以定性),其中不同年龄的脂质沉积发生率和不同性别的骨质增生的发生率组间比较,差异有统计学意义(x^2=10.702,x^2=5.100;P<0.05),且前者漏报率最高。经柏拉图及鱼骨图分析显示,该不良事件的主要原因为忽视骨退变类信号的观察、申请单信息不全、报告过于简单等。结论:腹盆区常规MRI检查骨骼异常信号漏报漏诊率高,开展针对性全面质量控制十分必要。

Objective: To investigate the misdiagnosis phenomenon and its causes of abnormal skeletal signals in MRI examination for abdominal and pelvic region. Methods: Hospitalized patients who underwent MRI and CT examination for abdominal or pelvic region were collected. Among them, the cases without abnormal skeletal signal in the MRI reports were screened out for further research. 3 senior doctors were organized to again find out whether there were abnormal signal of bone, and to analyze their pathological characteristics and type. Then, the causes of misdiagnosis were further tracked and analyzed. Results: In the reports of 95 patients with negative skeletal MRI, 71 skeletal abnormal signals were found out in 43 cases(45.2%), which could be classified into 9 pathological types, included 3 cases with suspected metastatic tumor, 16 cases with lipid deposit, 10 cases with osteoporosis, 7 cases with absorption cystic degeneration, 6 cases with Schmorl nodule, 2 cases with bone island, 1 case with vertebral compression, 1 case with terminal laminitis, and 3 cases which were difficult to be identified. Among them, the differences of incidences of lipid deposition between different age groups and of bone hyperplasia between different gender groups were significant respectively(x^2=10.702, x^2=5.100, P<0.05), and the misdiagnosis rate of the former was highest. The results of Platon analysis and fishbone diagram analysis showed that the main causes of these adverse events included the neglect for the observation of bone degeneration signal, the incomplete information of application form and too simple report. Conclusion: The rate of misdiagnosis of skeletal abnormalities by routine MRI in abdominal and pelvic region is high, so it is necessary to carry out pertinent and comprehensive quality control.