Dept of Diagnostic Radiology, Saitama International Medical Ctr, Saitama Medical Univ, Hidaka, Saitama 3501298, Japan.
Radiology. 2013 Mar;266(3):936-44. doi: 10.1148/radiol.12112516. Epub 2012 Dec 6.
To quantify observer agreement and analyze causes of disagreement in identifying honeycombing at chest computed tomography (CT).
The institutional review board approved this multiinstitutional HIPAA-compliant retrospective study, and informed patient consent was not required. Five core study members scored 80 CT images with a five-point scale (5 = definitely yes to 1 = definitely no) to establish a reference standard for the identification of honeycombing. Forty-three observers from various subspecialties and geographic regions scored the CT images by using the same scoring system. Weighted κ values of honeycombing scores compared with the reference standard were analyzed to investigate intergroup differences. Images were divided into four groups to allow analysis of imaging features of cases in which there was disagreement: agreement on the presence of honeycombing, agreement on the absence of honeycombing, disagreement on the presence of honeycombing, and other (none of the preceding three groups applied).
Agreement of scores of honeycombing presence by 43 observers with the reference standard was moderate (Cohen weighted κ values: 0.40-0.58). There were no significant differences in κ values among groups defined by either subspecialty or geographic region (Tukey-Kramer test, P = .38 to >.99). In 29% of cases, there was disagreement on identification of honeycombing. These cases included honeycombing mixed with traction bronchiectasis, large cysts, and superimposed pulmonary emphysema.
Identification of honeycombing at CT is subjective, and disagreement is largely caused by conditions that mimic honeycombing.
定量评估观察者在识别胸部 CT 蜂窝状影时的一致性，并分析导致意见分歧的原因。
本研究经机构审查委员会批准（遵循 HIPAA 规定），回顾性研究无需患者知情同意。5 名核心研究成员采用 5 分制（5 分表示“肯定有”，1 分表示“肯定无”）对 80 幅 CT 图像进行评分，以建立识别蜂窝状影的参考标准。来自不同亚专科和地理区域的 43 名观察者采用相同的评分系统对 CT 图像进行评分。分析蜂窝状影评分与参考标准之间的加权κ值，以研究组间差异。将图像分为 4 组，以允许分析存在分歧的病例的影像学特征：存在蜂窝状影的意见一致、不存在蜂窝状影的意见一致、存在蜂窝状影的意见不一致，以及其他（无上述三组适用的情况）。
43 名观察者的蜂窝状影评分与参考标准的一致性为中度（Cohen 加权κ值：0.40-0.58）。按亚专科或地理区域定义的组间κ值无显著差异（Tukey-Kramer 检验，P =.38 至>.99）。29%的病例在识别蜂窝状影时存在分歧。这些病例包括与牵拉性支气管扩张、大囊肿和重叠性肺气肿混合存在的蜂窝状影。
CT 上识别蜂窝状影具有主观性，且大多数意见分歧是由类似蜂窝状影的情况引起的。
