van Tubergen A, Heuft-Dorenbosch L, Schulpen G, Landewé R, Wijers R, van der Heijde D, van Engelshoven J, van der Linden Sj
University Hospital Maastricht, The Netherlands.
Ann Rheum Dis. 2003 Jun;62(6):519-25. doi: 10.1136/ard.62.6.519.
To assess performance of radiologists and rheumatologists in detecting sacroiliitis
100 rheumatologists and 23 radiologists participated. One set of films was used for each assessment, another for training, and the third for confidence judgment. Films of HLA-B27+ patients with AS were used to assess sensitivity. For specificity films of healthy HLA-B27- relatives were included. Plain sacroiliac (SI) films with simultaneously taken computed tomographic scans (CTs) were used for confidence judgment. Three months after reading the training set, sensitivity and specificity assessments were repeated. Next, participants attended a workshop. They also rated 26 SI radiographs and 26 CTs for their trust in each judgment. Three months later final assessments were done.
Sensitivity (84.3%/79.8%) and specificity (70.6%/74.7%) for radiologists and rheumatologists were comparable. Rheumatologists showed 6.3% decrease in sensitivity after self education (p=0.001), but 3.0% better specificity (p=0.008). The decrease in sensitivity reversed after the workshop. Difference in sensitivity three months after the workshop and baseline was only 0.5%. Sensitivity <50% occurred in 13% of participants. Only a few participants showed changes of >5% in both sensitivity and specificity. Intraobserver agreement for sacroiliitis grade 1 or 2 ranged from 65% to 100%. Sensitivity for CT (86%) was higher than for plain films (72%) (p<0.001) with the same specificity (84%). Confidence ratings for correctly diagnosing presence (7.7) or absence (8.3) of sacroiliitis were somewhat higher than incorrectly diagnosing the presence (6.6) or absence (7.4) of sacroiliitis (p<0.001).
Radiologists and rheumatologists show modest sensitivity and specificity for sacroiliitis and sizeable intraobserver variation. Overall, neither individual training nor workshops improved performance.
评估放射科医生和风湿病医生检测骶髂关节炎的表现。
100名风湿病医生和23名放射科医生参与。每次评估使用一组胶片，另一组用于培训，第三组用于信心判断。使用HLA - B27阳性的强直性脊柱炎（AS）患者的胶片评估敏感性。为评估特异性，纳入了健康的HLA - B27阴性亲属的胶片。使用同时进行计算机断层扫描（CT）的普通骶髂关节（SI）胶片进行信心判断。在阅读培训组胶片三个月后，重复进行敏感性和特异性评估。接下来，参与者参加了一个研讨会。他们还对26张SI射线照片和26张CT进行评分，以表明他们对每次判断的信任程度。三个月后进行最终评估。
放射科医生和风湿病医生的敏感性（84.3%/79.8%）和特异性（70.6%/74.7%）相当。风湿病医生在自我教育后敏感性下降了6.3%（p = 0.001），但特异性提高了3.0%（p = 0.008）。研讨会后敏感性的下降得到了逆转。研讨会三个月后与基线相比，敏感性差异仅为0.5%。13%的参与者敏感性<50%。只有少数参与者的敏感性和特异性变化>5%。骶髂关节炎1级或2级的观察者内一致性范围为65%至100%。CT的敏感性（86%）高于普通胶片（72%）（p<0.001），特异性相同（84%）。正确诊断骶髂关节炎存在（7.7）或不存在（8.3）的信心评分略高于错误诊断骶髂关节炎存在（6.6）或不存在（7.4）的信心评分（p<0.001）。
放射科医生和风湿病医生对骶髂关节炎的敏感性和特异性一般，且观察者内差异较大。总体而言，个体培训和研讨会均未提高表现。
