Collin David, Dunker Dennis, Göthlin Jan H, Geijer Mats
Department of Radiology, Sahlgrenska University Hospital, Mölndal, Sweden.
Acta Radiol. 2011 Oct 1;52(8):871-4. doi: 10.1258/ar.2011.110032. Epub 2011 Aug 26.
Conventional radiography is insufficient for diagnosis in a small but not unimportant number of hip fractures, and secondary imaging with computed tomography (CT) or magnetic resonance imaging (MRI) is warranted. There are no convincing observer variation studies performed for conventional radiography or CT in occult fractures, and no large materials for MRI.
To assess observer variation in radiography, CT and MRI of suspected occult, non-displaced hip fractures, and to evaluate to what extent observer experience or patient age may influence observer performance.
A total of 375 patients after hip trauma where radiography was followed by CT or MRI to evaluate a suspected occult hip fracture were collected retrospectively from two imaging centers. After scoring by three observers with varying degrees of radiologic experience, observer variation was assessed by using linear weighted kappa statistics.
For radiography, agreements between the three observers were moderate to substantial for intracapsular fractures, with kappa values in the ranges of 0.56-0.66. Kappa values were substantial for extracapsular fractures, in the ranges of 0.69-0.72. With increasing professional experience, fewer fractures were classified as equivocal at radiography. For CT and MRI, observer agreements were similar and almost perfect, with kappa values in the ranges of 0.85-0.97 and 0.93-0.97.
There were almost perfect observer agreements for CT and MRI in diagnosing non-displaced, occult hip fractures. Observer agreements for radiography were moderate to substantial, and observer experience influenced agreement only at radiography.
对于少数但并非不重要的髋部骨折，传统X线摄影不足以用于诊断，因此需要计算机断层扫描（CT）或磁共振成像（MRI）进行二次成像。目前尚无针对隐匿性骨折的传统X线摄影或CT的令人信服的观察者变异研究，也没有关于MRI的大量资料。
评估疑似隐匿性、无移位髋部骨折的X线摄影、CT和MRI检查中的观察者变异，并评估观察者经验或患者年龄在多大程度上可能影响观察者的表现。
回顾性收集了两个影像中心的375例髋部创伤患者，这些患者在进行X线摄影后接受了CT或MRI检查，以评估疑似隐匿性髋部骨折。由三名具有不同程度放射学经验的观察者进行评分后，使用线性加权kappa统计量评估观察者变异。
对于X线摄影，三名观察者对囊内骨折的一致性为中等至高度，kappa值在0.56 - 0.66范围内。对于囊外骨折，kappa值为高度，在0.69 - 0.72范围内。随着专业经验的增加，X线摄影中被分类为可疑的骨折数量减少。对于CT和MRI，观察者之间的一致性相似且几乎完美，kappa值在0.85 - 0.97和0.93 - 0.97范围内。
在诊断无移位、隐匿性髋部骨折方面，CT和MRI的观察者一致性几乎完美。X线摄影的观察者一致性为中等至高度，且仅在X线摄影中观察者经验会影响一致性。
