van Grinsven Susan, van Loon Corné, van Gorp Maarten, van Kints Marjolijn, Konings Peer, van Kampen Albert
Department of Orthopaedics, Rijnstate Hospital, PO Box 9555, 6800 TA Arnhem, The Netherlands.
Department of Radiology, Rijnstate Hospital, PO Box 9555, 6800 TA Arnhem, The Netherlands.
Eur J Radiol. 2015 Nov;84(11):2242-9. doi: 10.1016/j.ejrad.2015.07.016. Epub 2015 Jul 21.
To prospectively evaluate the diagnostic performance of magnetic-resonance-arthrography (MRA) by experienced musculoskeletal radiologists in patients with traumatic-anterior-shoulder-instability (TASI), after feedback protocol execution.
Forty-five surgically confirmed MRA's were used to enhance personal feedback, to discuss differences in outcome between MRA assessment and surgical findings and to fine-tune definition interpretation agreement of 7 different TASI-related lesions, between experienced musculoskeletal radiologists and experienced orthopaedic shoulder surgeons. After execution of the feedback protocol 20 new, surgically confirmed, MRA's were assessed by 2 experienced musculoskeletal radiologists using a seven-lesion standardized scoring form. Kappa coefficients, sensitivity, specificity, and differences in percentage agreement or correct diagnosis (p-value, McNemar's test) were calculated per lesion and overall per 7 lesion types to assess whether diagnostic reproducibility and accuracy was improved.
Per 7 lesion types, the overall kappa and percentage of agreement, between the 2 radiologists, were dramatically increased in comparison with our former study (k=0.81 versus k=0.48 and 90.7% versus 78.2%, respectively). The overall sensitivity of radiologist 1 increased from 45.9% to 87.8%, the overall sensitivity of radiologist 2 increased from 63.5% to 79.6% and the overall specificity of radiologist 2 increased from 80.1% to 85.7%. Furthermore, the overall percentage of correct diagnosis of both radiologist was also exceedingly higher (85.7% and 83.6%) compared to our former study (74.4% and 74.8%).
The implementation of our feedback protocol dramatically improved the reproducibility and accuracy of high field MRA by experienced musculoskeletal radiologist in patients with traumatic anterior shoulder instability.
在执行反馈方案后，前瞻性评估经验丰富的肌肉骨骼放射科医生利用磁共振关节造影（MRA）对创伤性前肩不稳（TASI）患者的诊断性能。
使用45例经手术证实的MRA来加强个人反馈，讨论MRA评估与手术结果之间的差异，并在经验丰富的肌肉骨骼放射科医生和经验丰富的骨科肩部外科医生之间，对7种不同的TASI相关病变的定义解释一致性进行微调。在执行反馈方案后，2名经验丰富的肌肉骨骼放射科医生使用七病变标准化评分表对20例新的、经手术证实的MRA进行评估。计算每个病变以及7种病变类型总体的kappa系数、敏感性、特异性以及一致性百分比或正确诊断的差异（p值，McNemar检验），以评估诊断的可重复性和准确性是否得到改善。
与我们之前的研究相比，对于7种病变类型，两名放射科医生之间的总体kappa值和一致性百分比显著提高（分别为k = 0.81对k = 0.48以及90.7%对78.2%）。放射科医生1的总体敏感性从45.9%提高到87.8%，放射科医生2的总体敏感性从63.5%提高到79.6%，放射科医生2的总体特异性从80.1%提高到85.7%。此外，与我们之前的研究（74.4%和74.8%）相比，两名放射科医生的总体正确诊断百分比也极高（85.7%和83.6%）。
我们的反馈方案显著提高了经验丰富的肌肉骨骼放射科医生利用高场MRA对创伤性前肩不稳患者诊断的可重复性和准确性。
