脂肪抑制T_(2)WI对肾透明细胞癌可能性评分阅片者间一致性和诊断效能的影响

Interobserver agreement and diagnostic performance assessment of clear cell likelihood score using T_(2)WI with fat suppression technique

目的探讨脂肪抑制T_(2)WI(FS-T_(2)WI)对2.0版肾透明细胞癌可能性评分(ccLS v2.0)阅片者间一致性和对肾透明细胞癌(ccRCC)诊断效能的影响。方法回顾性分析2021年1月至12月解放军总医院第一医学中心经病理证实的111例肾脏小肿瘤(SRM)患者的MRI图像,ccRCC 82例,非ccRCC 29例。由2名放射科医师基于T_(2)WI信号强度(低、等、高)和其他MRI征象独立评估ccLS分数(ccLS-T_(2)WI),间隔1个月后,再基于频率选择饱和法FS-T_(2)WI和其他MRI征象独立评估ccLS分数(ccLS-FS-T_(2)WI)。SRM在T_(2)WI和FS-T_(2)WI上信号强度的差异比较采用Fisher确切概率法。运用加权Kappa检验评价2名医师间ccLS-T_(2)WI和ccLS-FS-T_(2)WI一致性,并采用Gwet一致性系数对加权Kappa系数的差异进行比较。绘制受试者操作特征曲线评估ccLS-T_(2)WI和ccLS-FS-T_(2)WI诊断ccRCC的效能,曲线下面积(AUC)的比较采用DeLong检验。结果111例SRM的T_(2)WI和FS-T_(2)WI信号强度分布差异有统计学意义(χ^(2)=126.33,P<0.001),88例(79.3%)T_(2)WI和FS-T_(2)WI信号强度一致、23例(20.7%)信号强度发生变化。2名医师间ccLS-T_(2)WI的加权Kappa系数为0.57(95%CI 0.45~0.69),ccLS-FS-T_(2)WI的加权Kappa系数为0.55(95%CI 0.42~0.67),差异无统计学意义(t=-0.65,P=0.520)。ccLS-T_(2)WI诊断ccRCC的AUC为0.92(95%CI 0.86~0.97),ccLS-FS-T_(2)WI诊断ccRCC的AUC为0.91(95%CI 0.85~0.96),差异无统计学意义(Z=1.50,P=0.133)。结论基于T_(2)WI和FS-T_(2)WI的ccLS v2.0阅片者间一致性和对ccRCC的诊断效能相当,FS-T_(2)WI同样适用于ccLS v2.0的临床应用。

Objectives To investigate the effect of fat suppression(FS)T_(2)WI on the interobserver agreement and diagnostic performance of clear cell likelihood score version 2.0(ccLS v2.0)for clear cell renal cell carcinoma(ccRCC).Methods In this retrospective study,the MR images of 111 patients with pathologically confirmed small renal masses(SRM)from January to December 2021 were analyzed in the First Medical Centre,Chinese PLA General Hospital.Of the 111 SRM,82 cases were ccRCC and 29 cases were non-ccRCC.Two radiologists independently assessed ccLS scores based on T_(2)WI signal intensity(hypointense,isointense,hyperintense)and other MRI features(ccLS-T_(2)WI).After a one-month interval,the ccLS scores were independently evaluated utilizing the frequency-selective saturation FS-T_(2)WI and other MRI features(ccLS-FS-T_(2)WI).Fisher′s exact test was used to compare the difference in SRM signal intensity on T_(2)WI and FS-T_(2)WI.The weighted Kappa test was performed to assess the interobserver agreement of the two radiologists,and differences in the weighted Kappa coefficients were compared using the Gwet consistency coefficient.Receiver operating characteristic curves were drawn to evaluate the diagnostic performance of ccLS-T_(2)WI and ccLS-FS-T_(2)WI in diagnosing ccRCC,and the area under the curve(AUC)was compared utilizing the DeLong test.Results The signal intensity of 111 SRM on T_(2)WI and FS-T_(2)WI had statistically significant difference(χ^(2)=126.33,P<0.001),consistent in 88 cases(79.3%)and varied in 23 cases(20.7%).The weighted Kappa coefficient of ccLS-T_(2)WI was 0.57(95%CI 0.45-0.69)between the two radiologists,and the weighted Kappa coefficient of ccLS-FS-T_(2)WI was 0.55(95%CI 0.42-0.67),and the difference was not statistically significant(t=-0.65,P=0.520).The AUC of ccLS-T_(2)WI for ccRCC diagnosis was 0.92(95%CI 0.86-0.97),while the AUC of ccLS-FS-T_(2)WI for ccRCC diagnosis was 0.91(95%CI 0.85-0.96),and the difference was not statistically significant(Z=1.50,P=0.133).Conclusions The interobserver agreement and diagnostic performance of ccLS v2.0 based on T_(2)WI and FS-T_(2)WI sequences for ccRCC are comparable,and FS-T_(2)WI is applicable for the clinical application of ccLS v2.0.