van Grinsven S, Hagenmaier F, van Loon C J M, van Gorp M J, van Kints M J, van Kampen A
Department of Orthopaedics, Rijnstate Hospital, PO Box 9555, 6800 TA, Arnhem, The Netherlands.
Department of Orthopaedics, Rijnstate Hospital, PO Box 9555, 6800 TA, Arnhem, The Netherlands.
Clin Radiol. 2014 Nov;69(11):1157-64. doi: 10.1016/j.crad.2014.07.009. Epub 2014 Sep 15.
To prospectively evaluate the influence of observer experience, consensus assessment, and abduction and external rotation (ABER) view on the diagnostic performance of magnetic resonance arthrography (MRA) in patients with traumatic anterior-shoulder instability (TASI).
Fifty-eight MRA examinations (of which 51 had additional ABER views) were assessed by six radiologists (R1-R6) and three teams (T1-T3) with different experience levels, using a seven-lesion standardized scoring form. Forty-five out of 58 MRA examination findings were surgically confirmed. Kappa coefficients, sensitivity, specificity, and differences in percent agreement or correct diagnosis (p-value, McNemar's test) were calculated per lesion and overall per seven lesion types to assess diagnostic reproducibility and accuracy.
Overall kappa ranged from poor (k = 0.17) to moderate (k = 0.53), sensitivity from 30.6-63.5%, and specificity from 73.6-89.9%. Overall, the most experienced radiologists (R1-R2) and teams (T2-T3) agreed significantly more than the lesser experienced radiologists (R3-R4: p = 0.014, R5-R6; p = 0.018) and teams (T2-T3: p = 0.007). The most experienced radiologist (R1, R2, R3) and teams (T1, T2) were also consistently more accurate than the lesser experienced radiologists (R4, R5, R6) and team (T3). Significant differences were found between R1-R4 (p = 0.012), R3-R4 (p = 0.03), and T2-T3 (p = 0.014). The overall performance of consensus assessment was systematically higher than individual assessment. Significant differences were established between T1-T2 and radiologists R3-R4 (p<0.001, p = 0.001) and between T2 and R3 (p<0.001/p = 0.001) or R4 (p = 0.050). No overall significant differences were found between the radiologists' assessments with and without ABER.
The addition of ABER does not significantly improve overall diagnostic performance. The radiologist's experience level and consensus assessment do contribute to higher reproducibility and accuracy.
前瞻性评估观察者经验、一致性评估以及外展外旋（ABER）位视图对创伤性肩关节前不稳定（TASI）患者磁共振关节造影（MRA）诊断性能的影响。
6名放射科医生（R1 - R6）和3个经验水平不同的团队（T1 - T3）使用七病灶标准化评分表对58例MRA检查（其中51例有额外的ABER位视图）进行评估。58例MRA检查结果中的45例经手术证实。计算每个病灶以及七种病灶类型总体的kappa系数、敏感性、特异性以及一致率或正确诊断的差异（p值，McNemar检验），以评估诊断的可重复性和准确性。
总体kappa值范围从较差（k = 0.17）到中等（k = 0.53），敏感性从30.6%至63.5%，特异性从73.6%至89.9%。总体而言，经验最丰富的放射科医生（R1 - R2）和团队（T2 - T3）的一致性显著高于经验较少的放射科医生（R3 - R4：p = 0.014，R5 - R6；p = 0.018）和团队（T2 - T3：p = 0.007）。经验最丰富的放射科医生（R1、R2、R3）和团队（T1、T2）在准确性上也始终高于经验较少的放射科医生（R4、R5、R6）和团队（T3）。在R1 - R4（p = 0.012）、R3 - R4（p = 0.03）以及T2 - T3（p = 0.014）之间发现了显著差异。一致性评估的总体表现系统地高于个体评估。在T1 - T2与放射科医生R3 - R4（p<0.001，p = 0.001）之间以及T2与R3（p<0.001/p = 0.001）或R4（p = 0.050）之间存在显著差异。放射科医生在有和没有ABER位视图的评估之间未发现总体显著差异。
添加ABER位视图并未显著提高总体诊断性能。放射科医生的经验水平和一致性评估确实有助于提高可重复性和准确性。
