From the Department of Radiology, Division of Thoracic Imaging and Intervention (J.B.A., S.R.D., J.O.S.), Department of Surgery (H.A.G., M.L., C.D.W.), and Institute for Technology Assessment (E.F.H.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Founders House 202, Boston, MA 02114.
Radiology. 2016 Aug;280(2):464-74. doi: 10.1148/radiol.2016152004. Epub 2016 Feb 24.
Purpose To determine the impact of nonvascular thoracic magnetic resonance (MR) imaging on the clinical decision making and diagnostic certainty of thoracic surgeons. Materials and Methods Seven thoracic surgeons at Massachusetts General Hospital, an academic quaternary referral hospital, participated in this 2-year, prospective, institution review board-approved, HIPAA-compliant pre- and post-MR imaging survey study after completing a one-time demographic survey. Between July 16, 2013, and July 13, 2015, each time a thoracic surgeon ordered a nonvascular thoracic MR imaging study via radiology order entry, he or she was sent a link to the pre-test survey that ascertained the clinical rationale for MR imaging, the clinical management plan if MR imaging was not an option, and pre-test diagnostic certainty. Upon completion of the MR imaging report, the surgeon was sent a link to the post-test survey assessing if/how MR imaging changed clinical management, the surgeon's comfort with the clinical management plan, and post-test diagnostic certainty. Data were analyzed with Student t, Wilcoxon, and McNemar tests. Results A total of 99 pre- and post-test surveys were completed. Most MR imaging studies (64 of 99 [65%]) were requested because of indeterminate computed tomographic findings. The use of MR imaging significantly reduced the number of planned surgical interventions (P < .001), modified the surgical approach in 54% (14 of 26) of surgical cases, and increased surgeon comfort with the patient management plan in 95% (94 of 99) of cases. Increased diagnostic certainty as a result of MR imaging was highly significant (P < .0001). In 21% (21 of 99) of cases, definitive MR imaging results warranted no further follow-up or clinical care. Conclusion In appropriate cases, assessment with nonvascular thoracic MR imaging substantially affects the clinical decision making and diagnostic certainty of thoracic surgeons. (©) RSNA, 2016 Online supplemental material is available for this article. An earlier incorrect version of this article appeared online. This article was corrected on May 2, 2016.
目的 确定非血管性胸部磁共振成像（MR 成像）对胸外科医生临床决策和诊断确定性的影响。
材料与方法 2013 年 7 月 16 日至 2015 年 7 月 13 日，在马萨诸塞州综合医院（学术四级转诊医院）的 7 位胸外科医生完成了一次性人口统计学调查后，参与了这项为期 2 年的前瞻性机构审查委员会批准的 HIPAA 合规性 MR 成像前后调查研究。每次胸外科医生通过放射科医嘱输入系统下非血管性胸部 MR 成像检查医嘱时，他或她都会收到一个链接，该链接会确定 MR 成像的临床依据、如果不能进行 MR 成像的情况下的临床处理方案以及预测试诊断确定性。完成 MR 成像报告后，外科医生会收到一个链接，评估 MR 成像如何改变临床管理、外科医生对临床管理计划的满意度以及后测试诊断确定性。使用学生 t 检验、Wilcoxon 检验和 McNemar 检验进行数据分析。
结果 共完成 99 份前后测试调查。99 项研究中，64 项（65%）是由于 CT 检查结果不确定而要求进行的。MR 成像的应用显著减少了计划手术干预的数量（P <.001），改变了 54%（26 例中的 14 例）的手术方法，并增加了 95%（99 例中的 94 例）患者管理计划的外科医生满意度。MR 成像后诊断确定性的提高具有显著意义（P <.0001）。在 21%（99 例中的 21 例）的病例中，明确的 MR 成像结果无需进一步随访或临床护理。
结论 在适当的情况下，非血管性胸部 MR 成像评估会极大地影响胸外科医生的临床决策和诊断确定性。
