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使用磁共振成像诊断犬类推定缺血性脊髓病和急性非压迫性髓核突出症的观察者间和观察者内一致性

INTER- AND INTRAOBSERVER AGREEMENT FOR DIAGNOSING PRESUMPTIVE ISCHEMIC MYELOPATHY AND ACUTE NONCOMPRESSIVE NUCLEUS PULPOSUS EXTRUSION IN DOGS USING MAGNETIC RESONANCE IMAGING.

作者信息

Fenn Joe, Drees Randi, Volk Holger A, Decker Steven De

机构信息

Department of Clinical Science and Services, Royal Veterinary College, Hawkshead Lane, North Mymms, Hertfordshire, AL9 7TA, UK.

出版信息

Vet Radiol Ultrasound. 2016 Jan;57(1):33-40. doi: 10.1111/vru.12289. Epub 2015 Aug 25.

Abstract

Ischemic myelopathy (IM) and acute noncompressive nucleus pulposus extrusion (ANNPE) are common spinal emergencies in dogs with similar clinical presentations. Magnetic resonance imaging (MRI) criteria for a presumptive antemortem diagnosis have been reported, however inter- and intraobserver agreement for use of these criteria has not been established. The aim of this retrospective, descriptive, cross-sectional study was to describe inter- and intraobserver agreement for using previously published MRI criteria to diagnose presumptive IM and ANNPE in a sample dogs. Dogs with a presumptive diagnosis of IM or ANNPE and available MRI scan data were retrieved from medical record archives during the period of 2009 and 2013. A total of 127 dogs were identified. From this sample, MRI scans for 60 dogs were randomly selected and duplicated for intraobserver analysis, giving a total of 187 anonymized studies that were presented to two blinded assessors (one board-certified veterinary neurologist, one board-certified veterinary radiologist). Assessors were asked to diagnose lesions as IM or ANNPE based on previously published MRI characteristics. Interobserver agreement in diagnosing IM or ANNPE was moderate (Kappa = 0.56) and intraobserver agreement was moderate to good (Assessor 1 Kappa = 0.79, Assessor 2 Kappa = 0.47). Agreement was strongest for detecting presence of lesions overlying a vertebral body (94% of lesions that were diagnosed as IM) or overlying an intervertebral disk (85% of lesions that were diagnosed as ANNPE). Findings indicated that use of previously published MRI criteria yields moderate inter- and moderate to good intraobserver agreement for a presumptive diagnosis of IM or ANNPE in dogs.

摘要

缺血性脊髓病(IM)和急性非压迫性髓核突出症(ANNPE)是犬类常见的脊柱急症,临床表现相似。虽然已有关于生前推定诊断的磁共振成像(MRI)标准的报道,但尚未确定这些标准在观察者间和观察者内的一致性。这项回顾性、描述性、横断面研究的目的是描述在一组犬类样本中,使用先前发表的MRI标准诊断推定的IM和ANNPE时观察者间和观察者内的一致性。2009年至2013年期间,从病历档案中检索出推定诊断为IM或ANNPE且有可用MRI扫描数据的犬只。共识别出127只犬。从该样本中,随机选择60只犬的MRI扫描图像并复制用于观察者内分析,总共得到187份匿名研究资料,提供给两名盲法评估者(一名获得委员会认证的兽医神经学家,一名获得委员会认证的兽医放射学家)。要求评估者根据先前发表的MRI特征将病变诊断为IM或ANNPE。观察者间诊断IM或ANNPE的一致性为中等(Kappa = 0.56),观察者内一致性为中等至良好(评估者1的Kappa = 0.79,评估者2的Kappa = 0.47)。对于检测椎体上方(94%被诊断为IM的病变)或椎间盘上方(85%被诊断为ANNPE的病变)的病变存在情况,一致性最强。研究结果表明,使用先前发表的MRI标准对犬类IM或ANNPE的推定诊断在观察者间具有中等一致性,在观察者内具有中等至良好的一致性。

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