Dormagen Johann Baptist, Gaarder Mario, Drolsum Anders
Department of Radiology, Oslo University Hospital, Ullevål, Oslo, Norway
Department of Radiology, Oslo University Hospital, Ullevål, Oslo, Norway.
Acta Radiol. 2015 Jan;56(1):3-9. doi: 10.1177/0284185113517228. Epub 2013 Dec 17.
One of the main disadvantages of conventional ultrasound is its operator dependency, which might impede the reproducibility of the sonographic findings. A new approach with cine-loops and standardized scan protocols can overcome this drawback.
To compare abdominal ultrasound findings of immediate bedside reading by performing radiologist with offline reading by a non-performing radiologist, using standardized cine-loop sequences.
Over a 6-month period, three radiologists performed 140 dynamic ultrasound organ-based examinations in 43 consecutive outpatients. Examination protocols were standardized and included predefined probe position and sequences of short cine-loops of the liver, gallbladder, pancreas, kidneys, and urine bladder, covering the organs completely in two planes. After bedside examinations, the studies were reviewed and read out immediately by the performing radiologist. Image quality was registered from 1 (no diagnostic value) to 5 (excellent cine-loop quality). Offline reading was performed blinded by a radiologist who had not performed the examination. Bedside and offline reading were compared with each other and with consensus results.
In 140 examinations, consensus reading revealed 21 cases with renal disorders, 17 cases with liver and bile pathology, and four cases with bladder pathology. Overall inter-observer agreement was 0.73 (95% CI 0.61-0.91), with lowest agreement for findings of the urine bladder (0.36) and highest agreement in liver examinations (0.90). Disagreements between the two readings were seen in nine kidneys, three bladder examinations, one pancreas and bile system examinations each, and in one liver, giving a total number of mismatches of 11%. Nearly all cases of mismatch were of minor clinical significance. The median image quality was 3 (range, 2-5) with most examinations deemed a quality of 3. Compared to consensus reading, overall accuracy was 96% for bedside reading and 94% for offline reading.
Standardized cine-loop documentation enables accurate offline reading in abdominal ultrasound and shows high agreement with immediate bedside reading.
传统超声的主要缺点之一是其对操作者的依赖性，这可能会妨碍超声检查结果的可重复性。采用电影环和标准化扫描协议的新方法可以克服这一缺点。
使用标准化电影环序列，比较由执行检查的放射科医生进行床边即时阅读与由非执行检查的放射科医生进行离线阅读的腹部超声检查结果。
在6个月的时间里，三名放射科医生对43例连续门诊患者进行了140次基于器官的动态超声检查。检查方案标准化，包括预定义的探头位置以及肝脏、胆囊、胰腺、肾脏和膀胱的短电影环序列，在两个平面上完全覆盖这些器官。床边检查后，执行检查的放射科医生立即对研究进行回顾和解读。图像质量从1（无诊断价值）到5（电影环质量极佳）进行记录。由未进行检查的放射科医生进行盲法离线阅读。将床边阅读和离线阅读相互比较，并与共识结果进行比较。
在140次检查中，共识阅读发现21例肾脏疾病、17例肝脏和胆汁病变以及4例膀胱病变。观察者间总体一致性为0.73（95%可信区间0.61 - 0.91），膀胱检查结果的一致性最低（0.36），肝脏检查的一致性最高（0.90）。两次阅读之间的分歧出现在9个肾脏、3次膀胱检查、各1次胰腺和胆汁系统检查以及1次肝脏检查中，总不匹配数为11%。几乎所有不匹配病例的临床意义都较小。图像质量中位数为3（范围2 - 5），大多数检查被认为质量为3。与共识阅读相比，床边阅读的总体准确率为96%，离线阅读为94%。
标准化电影环记录可实现腹部超声的准确离线阅读，且与床边即时阅读高度一致。
