Division of Infectious Diseases & International Health, Department of Medicine, 3306-Duke University Medical Center, Durham, NC 27710, USA.
Acad Radiol. 2010 Feb;17(2):157-62. doi: 10.1016/j.acra.2009.08.013. Epub 2009 Nov 11.
Chest radiographic findings are important for diagnosis and management of tuberculosis. The reliability of these findings is therefore of interest. We sought to describe interobserver reliability of chest radiographic findings in pulmonary tuberculosis, and to understand how the reliability of these findings might affect the utility of radiographic findings in predicting tuberculosis relapse.
Three blinded readers independently reviewed chest radiographs from a randomly selected group of 10% of HIV-seronegative subjects participating in a tuberculosis treatment trial. The three readers then arrived at a fourth, consensus radiographic interpretation.
A total of 241 films obtained from 99 patients were reviewed. Agreement among the independent readers was very good for the findings of bilateral disease (kappa = 0.71-0.86 among readers) and cavitation (kappa = 0.66-0.73). The original interpretation was reasonably sensitive and specific (compared to the consensus interpretation) for bilateral disease, but the sensitivity for cavity decreased from 81% for the 2-month film to 47% at end of treatment (P = 0.013). Substituting the consensus interpretation for the original interpretation increased the odds ratio for the association between cavitation on early chest radiograph and subsequent tuberculosis relapse from 4.97 to 8.97.
Radiographic findings were reasonably reliable between independent reviewers and the original interpretations. The original investigators, who knew the patient's clinical course, were less likely to identify cavitation on the end of treatment chest radiograph. Improving the reliability of these findings could improve the utility of chest radiographs for predicting tuberculosis relapse.
胸部 X 线表现对肺结核的诊断和治疗具有重要意义，因此其可靠性受到关注。我们旨在描述肺结核胸部 X 线表现的观察者间可靠性，并了解这些表现的可靠性如何影响 X 线在预测肺结核复发中的作用。
三位观察者独立对参加结核病治疗试验的 HIV 血清阴性患者中随机抽取的 10%患者的胸部 X 线片进行阅片，然后达成第四份共识性 X 线解释。
共阅片 241 张，来自 99 例患者。三位观察者对双侧病变（观察者间 κ 值为 0.71～0.86）和空洞（κ 值为 0.66～0.73）的判断一致性很好。原始解释对双侧病变具有较好的敏感性和特异性（与共识性解释相比），但空洞的敏感性从 2 个月胸片的 81%降至治疗结束时的 47%（P=0.013）。用共识性解释替代原始解释，使早期胸片空洞与随后肺结核复发之间的关联的比值比从 4.97 增加至 8.97。
观察者间的 X 线表现具有较好的可靠性，且原始解释也具有较好的可靠性。原始研究者了解患者的临床病程，更不可能在治疗结束时的胸片上识别出空洞。提高这些表现的可靠性可以提高 X 线在预测肺结核复发中的作用。
