European Radiology:如何在不同临床经验的放射科医师中实现无差别MTA评估?

2022-01-16 shaosai MedSci原创

颞叶内侧萎缩 (MTA)是与阿尔茨海默病有关的重要结构性发现,但MTA也可出现在临床前痴呆中。在临床实践中,结构成像的判析通常是基于放射科医生的视觉评估。

颞叶内侧萎缩 (MTA)是与阿尔茨海默病有关的重要结构性发现,但MTA也可出现在临床前痴呆中。在临床实践中,结构成像的判析通常是基于放射科医生的视觉评估。已有研究表明采用视觉评分量表(VRS)的结构化报告可以增加MTA的报告频率,但对准确性影响不大,同时也会影响认知障碍的诊断结果。

最近的一项欧洲调查显示,75%的机构在临床实践中使用VRS,其中82%的人经常使用白质变化量表,81%的人使用MTA量表;其他VRS则不太常见。缺乏培训是在临床实践中不使用VRS的主要原因。有学者认为,在实践中使用VRS会提高诊断的准确性然而,在评估MTA的准确性和模式间的一致性时,尚未有研究将评级与MTA的金标准评级进行比较

近日,发表在European Radiology杂志的一项研究评估非痴呆人群MTA评分的模式间一致性以及具有不同临床经验的放射科医生之间的准确性,使得MTA的识别及评估流程的标准化成为可能

四名评分者(两名初级放射科医生和两名高级神经放射科医生)使用Scheltens的MTA量表对CT和MRI扫描的MTA进行评分。将评分与两位经验丰富的神经放射学专家的共识评分进行比较,以估计真实的阳性和阴性率(TPR和TNR)以及MTA的高估和低估。以Cohen's κ(二分法数据)、Cohen's κw和双向混合、单一措施、一致性ICC(序数数据)表示的模式间一致性被确定。充分的一致性被定义为κ/κw≥0.80和ICC≥0.80(95%CI的意义水平≥0.65)。 

49名有认知障碍的受试者(中位年龄72岁,27%为异常MTA)被纳入研究。只有初级放射科医生达到了充分的一致,以Cohen's κ表示。所有评分者都达到了充分的一致,以Cohen's κw和ICC表示。真正的阳性率从69%到100%不等,TNR从85%到100%不等。没有观察到低估或高估MTA的情况。放射科医生之间的评分没有差异。 

 根据Scheltens的5分制MTA等级的图像示例)。每一侧都被单独评分,并给出总的最高分。MTA 0=无萎缩,MTA 1=脉络膜裂隙轻度增宽,MTA 2=脉络膜裂隙中度增宽,颞角轻度增宽,海马高度轻度下降。MTA 3 = 脉络膜裂隙严重增宽,颞角中度增宽,海马高度中度下降,MTA 4 = 脉络膜裂隙严重增宽,颞角严重增宽,海马高度严重下降。

本研究表明,当Scheltens的MTA量表用于对非痴呆人群进行MTA评分时,具有不同临床经验的放射科医生在不同的模式间达成了充分的一致,并且具有相似的准确性。然而,评分者之间的TPR不同,这可能是由于评分风格的差异。

 

原文出处

Claes Håkansson,Ashkan Tamaddon,Henrik Andersson,et al.Inter-modality assessment of medial temporal lobe atrophy in a non-demented population: application of a visual rating scale template across radiologists with varying clinical experience.DOI:10.1007/s00330-021-08177-1

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