CAJ | 학술논문

目的应用Kappa统计量评价MRI诊断腰椎间盘突出的一致性.方法检查100例腰腿痛患者的300个椎体.采用3.0 T MR扫描仪,脊柱表而线圈,应用快速自旋回波序列行腰椎矢状面T1WI及T2WI、横轴面T2WI.由2名放射科医师分别在有及无临床资料的情况下对其中50例患者的L3～4、L4～5、I5～S1椎间盘的膨出、突出进行2次评价;再由此2名医师在无临床资料的情况下共同对其中52例患者的156个腰椎间盘进行评价.应用Kappa统计量评价2名医师前后2次的诊断结果及其对相同病例诊断结果的一敛性.结果甲乙2名放射科医师前后2次诊断结果相符合的椎间盘数量分别为114和109个,不相符合的椎间盘数量分别为36和41个,诊断结果的一致性为中度,Kappa值分别为0.60±O.06和0.57±0.06.在有临床资料的情况下,腰椎间盘膨出的诊断较前明显增加,分别增加了10个和31个.在没有临床资料的情况下,2名放射科医师之间的诊断结果相符合的椎间盘数量为77个,不相符合者为79个,诊断结果的一致性为弱(Kappa=0.24±0.06).在有无临床资料的情况下,最大的诊断差异出现在对正常和膨出的腰椎间盘的鉴别上,2名医师2次诊断膨出的差异分别达20和30个,分别占各自总不符合率的55.6%(20/36)和73.2%(30/41);2名医师对156个椎间盘诊断膨出与正常的差异达56个,为总不符合率的70.9%(56/79).结论对腰椎间盘膨出判断的不一致是造成同一医师2次诊断结果和2名医师之间诊断结果Kappa值低的最主要原因.
목적 응용Kappa통계량평개MRI진단요추간반돌출적일치성.방법 검사100례요퇴통환자적300개추체.채용3.0 T MR소묘의,척주표이선권,응용쾌속자선회파서렬행요추시상면T1WI급T2WI、횡축면T2WI.유2명방사과의사분별재유급무림상자료적정황하대기중50례환자적L3～4、L4～5、I5～S1추간반적팽출、돌출진행2차평개;재유차2명의사재무림상자료적정황하공동대기중52례환자적156개요추간반진행평개.응용Kappa통계량평개2명의사전후2차적진단결과급기대상동병례진단결과적일렴성.결과 갑을2명방사과의사전후2차진단결과상부합적추간반수량분별위114화109개,불상부합적추간반수량분별위36화41개,진단결과적일치성위중도,Kappa치분별위0.60±O.06화0.57±0.06.재유림상자료적정황하,요추간반팽출적진단교전명현증가,분별증가료10개화31개.재몰유림상자료적정황하,2명방사과의사지간적진단결과상부합적추간반수량위77개,불상부합자위79개,진단결과적일치성위약(Kappa=0.24±0.06).재유무림상자료적정황하,최대적진단차이출현재대정상화팽출적요추간반적감별상,2명의사2차진단팽출적차이분별체20화30개,분별점각자총불부합솔적55.6%(20/36)화73.2%(30/41);2명의사대156개추간반진단팽출여정상적차이체56개,위총불부합솔적70.9%(56/79).결론대요추간반팽출판단적불일치시조성동일의사2차진단결과화2명의사지간진단결과Kappa치저적최주요원인.
Objective To assess the concordance of MRI diagnosis for patients suspected of lumbar disk herniation by using Kappa statistic.Methods One hundred patients(48 males and 52 females)with lumbosaeral radicular pain,aged from 17 to 86(average 61).All patients underwent fast spin-echo T1 and T2 weighted imaging on a 3.0 T MR scanner and spine surface coil.Two radiologists(doctor A and doctor B)evaluated the lumbar disks from L3-4,L4-5.and L5-S1 in 50 out of the 100 patients independently.The presence of a bulging disk or a herniation was reported.Images were interpreted twice:once before and once after disclosure of clinical information.And disks of 52 patients out of the 100 samples were interpreted by the two radiologists independently without clinical information as well.The Kappa statistics was employed to assess the concordance of each radiologist's diagnoses as well as the observer variation of the two radiologists.Results Diagnoses before and after disclosure to clinical information were concordant in 114 disks for doctor A and in 109 for doctor B.respectively.Diagnoses before and after disclosure to clinical information were not concordant in 36 disks for doctor A and in 41 disks for doctor B,respectively.The Kappa values were 0.60±0.06 and 0.57±0.06 for doctor A and doctor B,respectively.The concordance was moderate.After disclosure to elinical information.the numbers of reported bulging disks increased significantly.by 10 and 31 for doctor A and doctor B,respectively.Without clinical information,the diagnoses of the two radiologists were concordant in 77 disks,while not concordant in 79 disks.The interobserver agreement was poor(Kappa=0.24±0.06).The diffcrence on diagenoses made between with and without clinical information mainly happened on the differential diagnosis of normal disks and bulging disks.The different,diagnoses made between with and without clinical information were on 20 disks and on 30 disks for doctor A and doctor B,respectively;that accounted for 55.6%(20/36)and 73.2%(30/41)of total variation respectively.The diagnostic difference between the 2 doctors happened mainly on differentiation of bulging disks and normal disks,which happened in 56 disks,aceountiong for 70.9%(56/79)of total variation.Conclusion Variation on diagnoses of the same radiologist or between tworadiologists was mainly caused by disagreement on bulging disks.