Bansal Neil K, Hagiwara Mari, Borja Maria J, Babb James, Patel Sohil H
Department of Radiology, New York University Langone Medical Center, 550 1st Ave,New York, NY 10016.
Department of Radiology, University of Virginia Health System, PO Box 800170, Charlottesville, VA 22908.
Heliyon. 2016 Sep 16;2(9):e00162. doi: 10.1016/j.heliyon.2016.e00162. eCollection 2016 Sep.
Clinical history is known to influence interpretation of a wide range of radiologic examinations. We sought to evaluate the influence of the clinical history on MRI interpretation of optic neuropathy.
107 consecutive orbital MRI scans were retrospectively reviewed by three neuroradiologists. The readers independently evaluated the coronal STIR sequence for optic nerve hyperintensity and/or atrophy (yes/no) and the coronal post-contrast T1WI for optic nerve enhancement (yes/no). Readers initially evaluated the cases blinded to the clinical history. Following a two week washout period, readers again evaluated the cases with the clinical history provided. Inter-reader and reader-clinical radiologist agreement was assessed using Cohen's simple kappa coefficient.
Intra-reader agreement, without and with provision of clinical history, was 0.564-0.716 on STIR and 0.270-0.495 on post-contrast T1WI. Inter-reader agreement was overall fair-moderate. On post-contrast T1WI, inter-reader agreement was significantly higher when the clinical history was provided (p = 0.001). Reader-clinical radiologist agreement improved with provision of the clinical history to the readers on both the STIR and post-contrast T1WI sequences.
In the MRI assessment of optic neuropathy, only modest levels of inter-reader agreement were achieved, even after provision of clinical history. Provision of clinical history improved inter-reader agreement, especially when assessing for optic nerve enhancement. These findings confirm the subjective nature of orbital MRI interpretation in cases of optic neuropathy, and point to the importance of an accurate clinical history. Of note, the accuracy of orbital MRI in the context of optic neuropathy was not assessed, and would require further investigation.
已知临床病史会影响多种放射学检查的解读。我们旨在评估临床病史对视神经病变MRI解读的影响。
三位神经放射科医生对107例连续的眼眶MRI扫描进行回顾性分析。阅片者独立评估冠状位短TI反转恢复（STIR）序列上视神经高信号和/或萎缩情况（是/否），以及冠状位增强后T1加权成像（T1WI）上视神经强化情况（是/否）。阅片者最初在不了解临床病史的情况下评估病例。经过两周的洗脱期后，阅片者再次在提供临床病史的情况下评估病例。使用Cohen简单kappa系数评估阅片者之间以及阅片者与临床放射科医生之间的一致性。
阅片者自身在不提供和提供临床病史情况下的一致性，在STIR序列上为0.564 - 0.716，在增强后T1WI上为0.270 - 0.495。阅片者之间的一致性总体为中等。在增强后T1WI上，提供临床病史时阅片者之间的一致性显著更高（p = 0.001）。向阅片者提供临床病史后，阅片者与临床放射科医生在STIR序列和增强后T1WI序列上的一致性均有所提高。
在视神经病变的MRI评估中，即使提供了临床病史，阅片者之间的一致性水平也仅为中等。提供临床病史提高了阅片者之间的一致性，尤其是在评估视神经强化时。这些发现证实了视神经病变病例中眼眶MRI解读的主观性，并指出准确临床病史的重要性。值得注意的是，本研究未评估视神经病变情况下眼眶MRI检查的准确性，这需要进一步研究。
