Sohns Christian, Mangelsdorf Johanna, Sossalla Samuel, Konietschke Frank, Obenauer Silvia
Department of Cardiology and Pneumology/Heart Center, Georg-August-Universit ä t G ö ttingen, Germany.
Acta Radiol. 2010 Jun;51(5):512-21. doi: 10.3109/02841851003674520.
Advances in CT technology from single to multi-detector row CT (MDCT) permit a high resolution and volumetric presentation of pulmonary lesions. This implicates emerging measurement techniques that need to be contrasted with established methods.
To compare bidimensional, unidimensional, and volumetric methods for evaluation of treatment response in patients with lung lesions.
This study comprised 68 patients with pulmonary lesions who underwent a total of 276 64-MDCTs of chest at baseline and follow-up. RECIST and WHO criteria were used for unidimensional and bidimensional methods and region growing (RG) for volumetry. Patients were classified into four response categories. Respectively, two measurement techniques were contrasted and the kappa index was calculated. For intra-observer reproducibility the relative measurement error (RME) and kappa index with regard to agreement of response categories were evaluated.
Comparison of WHO und RECIST criteria achieves high correlation with kappa indices of 0.76 and 0.82. In particular, lesions with moderate increase of size in the range of 25-44% for bidimensional and 12-29% for unidimensional measurement result in different response categories when applying WHO and RECIST criteria. WHO criteria delivered PD more often than RECIST. kappa indices of 0.79 and 0.87 were attained in comparison of RECIST and RG, and 0.83 and 0.84 for WHO and RG. RME was 2.82% for RECIST, 7.53% for WHO, and 8.97% for RG. Intra-observer reproducibility was 95% for RECIST, 95% for WHO, and 96% for RG.
The comparison of all methods resulted in no statistically significant differences. WHO criteria seemed to diverge the most, they declared several lesions prematurely as progression, and showed no benefit in comparison to RECIST. RG showed the best reproducibility, considered irregular lesions, was slightly superior to RECIST, and could be applied uniformly. Unidimensional measurement represents an adequate alternative with the advantage of better clinical work flow.
CT技术从单层扫描发展到多排探测器CT（MDCT），使得肺部病变能够以高分辨率进行容积成像。这意味着需要将新兴的测量技术与既定方法进行对比。
比较二维、一维和容积测量方法在评估肺部病变患者治疗反应中的应用。
本研究纳入68例肺部病变患者，他们在基线期和随访期共接受了276次胸部64层MDCT扫描。一维和二维测量采用RECIST和WHO标准，容积测量采用区域生长（RG）法。将患者分为四个反应类别。分别对两种测量技术进行对比，并计算kappa指数。对于观察者内重复性，评估了反应类别一致性方面的相对测量误差（RME）和kappa指数。
WHO标准与RECIST标准的比较显示出高度相关性，kappa指数分别为0.76和0.82。特别是，在二维测量中大小中等增加25% - 44%、一维测量中增加12% - 29%的病变，应用WHO标准和RECIST标准时会导致不同的反应类别。WHO标准比RECIST标准更常判定为疾病进展（PD）。RECIST与RG比较的kappa指数分别为0.79和0.87，WHO与RG比较的kappa指数分别为0.83和0.84。RECIST的RME为2.82%，WHO为7.53%，RG为8.97%。观察者内重复性方面，RECIST为95%，WHO为95%，RG为96%。
所有方法的比较结果无统计学显著差异。WHO标准差异似乎最大，它过早地将多个病变判定为进展，与RECIST相比并无优势。RG显示出最佳的重复性，考虑了不规则病变，略优于RECIST，且可统一应用。一维测量是一种合适的替代方法，并具有临床工作流程更佳的优势。
