超声造影剂注射后观察者经验对肝脏良恶性肿瘤鉴别的影响。
Effect of observer experience in the differentiation between benign and malignant liver tumors after ultrasound contrast agent injection.
作者信息
Quaia Emilio, Alaimo Valerio, Baratella Elisa, Pizzolato Riccardo, Cester Giacomo, Medeot Alessandro, Cova Maria Assunta
机构信息
Department of Radiology, Cattinara Hospital, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy.
出版信息
J Ultrasound Med. 2010 Jan;29(1):25-36. doi: 10.7863/jum.2010.29.1.25.
OBJECTIVE
The purpose of this study was to assess the impact of the observer level of experience on the diagnostic performance of contrast-enhanced ultrasound imaging (CEUS) for differentiation between benign and malignant liver tumors.
METHODS
From a computerized search, we retrospectively identified 286 biopsy-proven liver tumors (105 hepatocellular carcinomas, 48 metastases, 7 intra-hepatic cholangiocarcinomas, 33 liver hemangiomas, and 93 nonhemangiomatous benign lesions) in 235 patients (140 male and 95 female; mean age +/- SD, 56 +/- 11 years) who underwent CEUS after sulfur hexafluoride-filled microbubble injection. The digital cine clips recorded during the arterial (10-35 seconds from injection), portal (50-120 seconds), and late (130-300 seconds) phases were analyzed by 6 independent observers without experience (group 1, observers 1-3) or with 2 to 10 years of experience in CEUS (group 2, observers 4-6). Specific training in the diagnostic and interpretative criteria was provided to the inexperienced observers. Each observer used a 5-point scale to grade diagnostic confidence: 1, definitely benign; 2, probably benign; 3, indeterminate; 4, probably malignant; or 5, definitely malignant on the basis of the enhancement pattern during the arterial phase and enhancement degree during the portal and late phases compared with the liver (hypoenhancement indicating malignant and isoenhancement to hyperenhancement indicating benign).
RESULTS
The analysis of observer diagnostic confidence revealed higher intragroup (kappa = 0.63-0.83) than intergroup (kappa = 0.47-0.63) observer agreement. The experienced observers showed higher diagnostic performance in malignancy diagnosis than did inexperienced observers (overall accuracy: group 1, 63.3%-72.8%; group 2, 75.9%-93.1%; P < .05, chi(2) test).
CONCLUSIONS
The diagnostic performance of CEUS in liver tumor characterization was dependant on the observer's level of experience.
目的
本研究旨在评估观察者的经验水平对超声造影成像（CEUS）鉴别肝脏良恶性肿瘤诊断性能的影响。
方法
通过计算机检索，我们回顾性纳入了235例患者（男性140例，女性95例；平均年龄±标准差，56±11岁）中286个经活检证实的肝脏肿瘤（105例肝细胞癌、48例转移瘤、7例肝内胆管癌、33例肝血管瘤和93例非血管瘤性良性病变），这些患者在注射六氟化硫微泡后接受了CEUS检查。由6名独立观察者分析动脉期（注射后10 - 35秒）、门脉期（50 - 120秒）和延迟期（130 - 300秒）记录的数字电影片段，其中3名观察者无经验（第1组，观察者1 - 3），另外3名观察者有2至10年CEUS经验（第2组，观察者4 - 6）。对无经验的观察者进行了诊断和解读标准的专门培训。每位观察者根据动脉期增强模式以及门脉期和延迟期与肝脏相比的增强程度（低增强提示恶性，等增强至高增强提示良性），使用5分制对诊断信心进行分级：1分，肯定为良性；2分，可能为良性；3分，不确定；4分，可能为恶性；5分，肯定为恶性。
结果
观察者诊断信心分析显示，组内观察者一致性（kappa = 0.63 - 0.83）高于组间（kappa = 0.47 - 0.63）。有经验的观察者在恶性肿瘤诊断中的表现优于无经验的观察者（总体准确率：第1组，63.3% - 72.8%；第2组，75.9% - 93.1%；P < 0.05，卡方检验）。
结论
CEUS在肝脏肿瘤特征性诊断中的性能取决于观察者的经验水平。
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