Boëchat Márcia Cristina Bastos, Mello Rosane Reis de, Dutra Maria Virgínia Peixoto, Silva Kátia Silveira da, Daltro Pedro, Marchiori Edson
Instituto Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
Sao Paulo Med J. 2010 May;128(3):130-6. doi: 10.1590/s1516-31802010000300005.
High-resolution computed tomography (HRCT) of the lungs is more sensitive than radiographs for evaluating pulmonary disease, but little has been described about HRCT interpretation during the neonatal period or shortly afterwards. The aim here was to evaluate the reliability of the interpretation of HRCT among very low birth weight premature infants (VLBWPI; < 1500 g).
Cross-sectional study on intra and interobserver reliability of HRCT on VLBWPI.
86 VLBWPI underwent HRCT. Two pediatric radiologists analyzed the HRCT images. The reliability was measured by the proportion of agreement, kappa coefficient (KC) and positive and negative agreement indices.
For radiologist A, the intraobserver reliability KC was 0.79 (confidence interval, CI: 0.54-1.00) for normal/abnormal examinations; for each abnormality on CT, KC ranged from 0.05 to 1.00. For radiologist B, the intraobserver reliability KC was 0.79 (CI: 0.54-1.00) for normal/abnormal examinations; for each abnormality on CT, KC ranged from 0.37 to 0.83. The interobserver agreement was 88% for normal/abnormal examinations and KC was 0.71 (CI: 0.5- 0.93); for most abnormal findings, KC ranged from 0.51-0.67.
For normal/abnormal examinations, the intra and interobserver agreements were substantial. For most of the imaging findings, the intraobserver agreement ranged from moderate to substantial. Our data demonstrate that in clinical practice, there is no reason for more than one tomographic image evaluator, provided that this person is well trained in VLBWPI HRCT interpretation. Analysis by different observers should be reserved for research and for difficult cases in clinical contexts.
肺部高分辨率计算机断层扫描（HRCT）在评估肺部疾病方面比X光片更敏感，但关于新生儿期或之后不久的HRCT解读的描述很少。本研究的目的是评估极低出生体重早产儿（VLBWPI；<1500g）HRCT解读的可靠性。
关于VLBWPI的HRCT观察者内和观察者间可靠性的横断面研究。
86例VLBWPI接受了HRCT检查。两名儿科放射科医生分析了HRCT图像。通过一致性比例、kappa系数（KC）以及阳性和阴性一致性指数来衡量可靠性。
对于放射科医生A，正常/异常检查的观察者内可靠性KC为0.79（置信区间，CI：0.54 - 1.00）；对于CT上的每种异常情况，KC范围为0.05至1.00。对于放射科医生B，正常/异常检查的观察者内可靠性KC为0.79（CI：0.54 - 1.00）；对于CT上的每种异常情况，KC范围为0.37至0.83。正常/异常检查的观察者间一致性为88%，KC为(0.71)（CI：0.5 - 0.93）；对于大多数异常发现，KC范围为0.51 - 0.67。
对于正常/异常检查，观察者内和观察者间的一致性很高。对于大多数影像学发现，观察者内一致性从中度到高度不等。我们的数据表明，在临床实践中，如果一个人在VLBWPI的HRCT解读方面训练有素，就没有理由安排多名断层图像评估人员。不同观察者的分析应保留用于研究和临床中遇到的疑难病例分析。
