Al-Khawari Hanaa, Athyal Reji P, Al-Saeed Osama, Sada Prio N, Al-Muthairi Sana, Al-Awadhi Adel
Department of Clinical Radiology, Faculty of Medicine, Kuwait University, Kuwait.
Ann Saudi Med. 2010 Mar-Apr;30(2):129-33. doi: 10.4103/0256-4947.60518.
Radiological and histological evaluations are affected by subjective interpretation. This study determined the level of inter- and intraobserver variation among radiologists for detection of abnormal parenchymal lung changes on high resolution computed tomography (HRCT).
HRCT images of 65 patients known to have systemic lupus erythematosus (with clinical pulmonary involvement) were retrospectively reviewed by four nonthoracic radiologists (two with expertise in magnetic resonance [MR] and two general radiologists). Each radiologist read the scans twice, with an interval between readings of at least 6 months. The interobserver variation among the first and second readings of the four radiologists and the intraobserver variation of each radiologist's two readings were assessed by the kappa statistic.
There was good agreement between the first and second readings of each radiologist. There was moderate agreement between the two readings of one MR radiologist (kappa=0.482); the other three radiologists had kappa values that were good to excellent (0.716, 0.691, and 0.829). There was a clinically acceptable level of interobserver variability between all radiologists. The agreement was fair to moderate between the MR radiologist and the other observers (kappa range: 0.362-0.519) and moderate to good between the other three radiologists (0.508-0.730).
The interpretation of imaging findings of abnormal parenchymal lung changes on HRCT is reproducible and the agreement between general radiologists is clinically acceptable. There is reduced agreement when the radiologist is not involved on a regular basis with thoracic imaging. Difficult or indeterminate cases may benefit from review by a chest radiologist.
放射学和组织学评估会受到主观解读的影响。本研究确定了放射科医生在高分辨率计算机断层扫描（HRCT）上检测肺部实质异常变化时观察者间和观察者内的变异程度。
对65例已知患有系统性红斑狼疮（伴有临床肺部受累）患者的HRCT图像进行回顾性分析，由四位非胸部放射科医生（两位具有磁共振成像[MR]专业知识，两位普通放射科医生）进行阅片。每位放射科医生阅片两次，阅片间隔至少6个月。通过kappa统计量评估四位放射科医生第一次和第二次阅片之间的观察者间变异以及每位放射科医生两次阅片的观察者内变异。
每位放射科医生的第一次和第二次阅片之间具有良好的一致性。一位MR放射科医生的两次阅片之间具有中等一致性（kappa=0.482）；其他三位放射科医生的kappa值为良好至优秀（0.716、0.691和0.829）。所有放射科医生之间的观察者间变异性处于临床可接受水平。MR放射科医生与其他观察者之间的一致性为中等至良好（kappa范围：0.362 - 0.519），其他三位放射科医生之间的一致性为中等至良好（0.508 - 0.730）。
HRCT上肺部实质异常变化的影像学表现解读具有可重复性，普通放射科医生之间的一致性在临床上是可接受的。不经常参与胸部影像学检查的放射科医生之间的一致性会降低。疑难或不确定的病例可能受益于胸部放射科医生的会诊。
