放射科医生之间通过计算机断层扫描诊断舟骨骨折的观察者间差异。
Interobserver variability among radiologists for diagnosis of scaphoid fractures by computed tomography.
作者信息
de Zwart Andele D, Beeres Frank J P, Kingma Lucas M, Otoide Marleen, Schipper Inger B, Rhemrev Steven J
机构信息
Department of Surgery, Landsteiner Institute, Medical Centre Haaglanden, The Hague.
出版信息
J Hand Surg Am. 2012 Nov;37(11):2252-6. doi: 10.1016/j.jhsa.2012.08.016.
PURPOSE
To determine the interobserver variability among radiologists for computed tomography (CT) diagnosis of scaphoid fractures.
METHODS
Four specialized musculoskeletal radiologists evaluated the CT scans of 150 consecutive patients who were clinically suspected of having sustained a scaphoid fracture but whose scaphoid-specific radiographs were normal. The radiologists were asked to determine the presence or absence of a scaphoid fracture and to localize the fracture. Interobserver agreement was calculated using the kappa statistic.
RESULTS
The radiologists diagnosed between 11 (7%) and 22 (15%) scaphoid fractures; the kappa value was 0.51.
CONCLUSION
Agreement on the presence of a scaphoid fracture and its location on a CT scan was moderate among the 4 radiologists. This finding raises the question as to whether scaphoid fractures could be under- or overdiagnosed in daily practice when CT is used to exclude or confirm a fracture. This should be kept in mind when interpreting clinical and radiological results in patients with suspected scaphoid fractures.
目的
确定放射科医生在计算机断层扫描（CT）诊断舟状骨骨折时的观察者间变异性。
方法
四位专业的肌肉骨骼放射科医生对150例连续患者的CT扫描进行评估，这些患者临床上怀疑发生舟状骨骨折，但舟状骨特异性X线片正常。要求放射科医生确定舟状骨骨折是否存在，并对骨折进行定位。使用kappa统计量计算观察者间的一致性。
结果
放射科医生诊断出11例（7%）至22例（15%）舟状骨骨折；kappa值为0.51。
结论
4位放射科医生在舟状骨骨折的存在及其在CT扫描上的位置方面的一致性为中等。这一发现提出了一个问题，即当使用CT排除或确认骨折时，在日常实践中舟状骨骨折是否可能被漏诊或误诊。在解释疑似舟状骨骨折患者的临床和放射学结果时应牢记这一点。
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