基于间质性肺病报告和数据系统的HRCT结构式报告及临床应用评价

Structured reporting of high-resolution CT based on ILD-RADS and its clinical application evaluation

目的 评估放射科医师使用基于HRCT的间质性肺病报告和数据系统(ILD-RADS)结构式报告的一致性,并分析风湿免疫科医生对结构式报告的评价。方法 回顾性纳入60例经临床确诊为间质性肺病(ILD)病人的胸部高分辨CT(HRCT)影像及临床资料。参照文献和指南构建ILD结构式报告模板,分析HRCT影像征象(肺纤维化征象、肺实质改变征象、其他征象),明确病人是否为ILD并进行ILD-RADS分级,分为0级(不完整评估)、1级[典型普通型间质性肺炎(UIP)]、2级(可能UIP)、3级(不确定UIP)和4级(非UIP)。由2名阅片者独立撰写结构式报告,另从报告工作站直接导出既往的传统叙述性报告。由3名风湿免疫科医师采用Likert量表对2种报告描述的完整性和清晰度进行评分。采用Kappa检验分析观察者间ILD结构式报告结果的一致性,采用秩和检验比较2种报告评分的差异。结果 2名阅片者对结构式报告评估的结果显示,ILD-RADS分级的评估均具有高度一致性(1-4级的κ值分别为0.812、0.839、0.856和0.861,总体κ值为0.878;均κ>0.80),对所有HRCT影像征象的评估有较高到高的一致性(均κ>0.60)。3名医师分别评估了2种报告的完整性和清晰度,对ILD结构式报告的评分均为10分。每名医师对结构式报告的完整性和清晰度评分均高于传统叙述式报告(均P<0.05)。结论 基于ILD-RADS构建的结构式报告可描述清晰、完整的影像征象,且不同医师间评估的一致性较高,对ILD的评估有较高实用性。

Objective To assess the consistency of structured reports generated by different radiologists based on high-resolution CT Interstitial Lung Disease Reporting and Data System(ILD-RADS),and to analyze the assessment of these reports by rheumatologists.Methods Chest HRCT imaging and clinical data of 60 patients with clinically diagnosed interstitial lung disease(ILD)were retrospectively analyzed.A structured reporting template was developed according to relevant literature and guidelines.The HRCT features were categorized into fibrotic features,parenchymal abnormalities,and other findings.The presence of ILD and ILD-RADS grading were determined:grade 0(incomplete evaluation),ILD-RADS 1(typical usual interstitial pneumonia[UIP]),ILD-RADS 2(probable UIP),ILD-RADS 3(indeterminate UIP),and ILD-RADS 4(non-UIP).Two radiologists independently generated structured reports,while traditional narrative reports were directly exported from the reporting system.Three rheumatologists rated the completeness and clarity of both reporting styles using a Likert scale.Inter-observer consistency for the structured reports was analyzed using the Kappa test,and differences in ratings between the two reporting methods were compared using the rank-sum test.Results The structured reporting evaluations by the two radiologists demonstrated high consistency for ILD-RADS grading(kappa values for grades 1-4:0.812,0.839,0.856,and 0.861;overall kappa=0.878;all kappa>0.80)and moderate-to-high consistency for HRCT feature assessments(all kappa>0.60).The three rheumatologists uniformly rated the structured reports as 10/10 for both completeness and clarity.Scores for the structured reports were significantly higher than those for traditional narrative reports(all P<0.05).Conclusion Structured reporting based on ILD-RADS can provide clear,completely and consistent image descriptions of imaging findings with high inter-observer consistency. This approach demonstrates strong practicality in the evaluation of ILD.