使用形态学术语描述重症急性胰腺炎的胰周积液：一项国际观察者间一致性研究

Describing peripancreatic collections in severe acute pancreatitis using morphologic terms: an international interobserver agreement study.

作者信息

van Santvoort Hjalmar C, Bollen Thomas L, Besselink Marc G, Banks Peter A, Boermeester Marja A, van Eijck Casper H, Evans Jonathan, Freeny Patrick C, Grenacher Lars, Hermans John J, Horvath Karen D, Hough David M, Laméris Johan S, van Leeuwen Maarten S, Mortele Koenraad J, Neoptolemos John P, Sarr Michael G, Vege Santhi Swaroop, Werner Jens, Gooszen Hein G

机构信息

Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.

出版信息

Pancreatology. 2008;8(6):593-9. doi: 10.1159/000161010. Epub 2008 Oct 13.

DOI:10.1159/000161010

PMID:18849641

Abstract

BACKGROUND/AIMS: The current terminology for describing peripancreatic collections in acute pancreatitis (AP) derived from the Atlanta Symposium (e.g. pseudocyst, pancreatic abscess) has shown a very poor interobserver agreement, creating the potential for patient mismanagement. A study was undertaken to determine the interobserver agreement for a new set of morphologic terms to describe peripancreatic collections in AP.

METHODS

An international, interobserver agreement study was performed: 7 gastrointestinal surgeons, 2 gastroenterologists and 8 radiologists in 3 US and 5 European tertiary referral hospitals independently evaluated 55 computed tomography (CT) scans of patients with predicted severe AP. The percentage agreement [median, interquartile range (IQR)] for 9 clinically relevant morphologic terms was calculated among all reviewers, and separately among radiologists and clinicians. The percentage agreement was defined as poor (<0.50), moderate (0.51-0.70), good (0.71-0.90), and excellent (0.91-1.00).

RESULTS

Overall agreement was good to excellent for the terms collection (percentage agreement = 1; IQR 0.68-1), relation with pancreas (1; 0.68-1), content (0.88; 0.87-1), shape (1; 0.78-1), mass effect (0.78; 0.62-1), loculated gas bubbles (1; 1-1), and air-fluid levels (1; 1-1). Overall agreement was moderate for extent of pancreatic nonenhancement (0.60; 0.46-0.88) and encapsulation (0.56; 0.48-0.69). The percentage agreement was greater among radiologists than clinicians for extent of pancreatic nonenhancement (0.75 vs. 0.57, p = 0.008), encapsulation (0.67 vs. 0.46, p = 0.001), and content (1 vs. 0.78, p = 0.008).

CONCLUSION

Interobserver agreement for the new set of morphologic terms to describe peripancreatic collections in AP is good to excellent. Therefore, we recommend that current clinically based definitions for CT findings in AP (e.g. pancreatic abscess) should no longer be used.

摘要

背景/目的：当前用于描述急性胰腺炎（AP）胰周积液的术语（如假性囊肿、胰腺脓肿）源自亚特兰大研讨会，但其观察者间一致性很差，可能导致患者管理不当。本研究旨在确定一组用于描述AP胰周积液的新形态学术语的观察者间一致性。

方法

进行了一项国际观察者间一致性研究：美国3家及欧洲5家三级转诊医院的7名胃肠外科医生、2名胃肠病学家和8名放射科医生独立评估了55例预测为重症AP患者的计算机断层扫描（CT）图像。计算了所有评估者之间以及放射科医生和临床医生之间9个临床相关形态学术语的一致性百分比[中位数，四分位间距（IQR）]。一致性百分比被定义为差（<0.50）、中等（0.51 - 0.70）、好（0.71 - 0.90）和优（0.91 - 1.00）。