Tiel-van Buul M M, van Beek E J, van Dongen A, van Royen E A
Department of Nuclear Medicine, University of Amsterdam, Netherlands.
Eur J Nucl Med. 1992;19(10):848-52. doi: 10.1007/BF00168159.
In the diagnosis of scaphoid fracture, the dynamic phase of the radionuclide bone scan alone has been recommended as an early test. To evaluate the independent reliability of the dynamic and static phases of the 3-phase bone scan in this diagnosis, 3 examiners reviewed the 3-phase bone scans of a series of 60 patients with clinical signs of fracture of the carpal scaphoid and with negative or non-diagnostic initial radiographs. The interpretation was performed independently and without the benefit of additional data. The bone scans were reviewed after 1 year by the same observers. The results were analyzed using kappa statistics. The bone scan was suspicious of fracture of the scaphoid in 15 patients. Irrespective of training and experience, the kappa values of the dynamic bone scan between any 2 observers did not exceed 0.57. The kappa values increased significantly when the static phase of the bone scan was examined (> 0.81). The intraobserver variability showed a similar pattern. We conclude that in suspected scaphoid fracture, the dynamic phase of the radionuclide bone scan alone cannot be used as a reliable diagnostic approach because of the low inter- and intraobserver agreement in the interpretation, irrespective of the experience and training of the observer.
在舟骨骨折的诊断中，有人建议仅将放射性核素骨扫描的动态期作为早期检查。为了评估三相骨扫描的动态期和静态期在该诊断中的独立可靠性，3名检查人员对一系列60例有腕舟骨骨折临床体征且最初X线片阴性或无法诊断的患者的三相骨扫描进行了复查。解读是独立进行的，且没有额外数据的帮助。1年后，相同的观察者对骨扫描进行了复查。结果采用kappa统计分析。15例患者的骨扫描怀疑有舟骨骨折。无论培训和经验如何，任意两名观察者之间动态骨扫描的kappa值均未超过0.57。当检查骨扫描的静态期时，kappa值显著增加（>0.81）。观察者内变异性呈现出类似的模式。我们得出结论，在疑似舟骨骨折的情况下，仅放射性核素骨扫描的动态期不能作为一种可靠的诊断方法，因为无论观察者的经验和培训如何，在解读中观察者间和观察者内的一致性都很低。
