Molecular Function and Imaging Program, the National Cardiac PET Centre and the Arrhythmia Service, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada.
First Department of Medicine, Hokkaido University School of Medicine, Sapporo, Japan.
J Nucl Med. 2017 Aug;58(8):1324-1329. doi: 10.2967/jnumed.116.187203. Epub 2017 Mar 2.
Recent studies have reported the usefulness of F-FDG PET in aiding with the diagnosis and management of patients with cardiac sarcoidosis (CS). However, image interpretation of F-FDG PET for CS is sometimes challenging. We sought to investigate the inter- and intraobserver agreement and explore factors that led to important discrepancies between readers. We studied consecutive patients with no significant coronary artery disease who were referred for assessment of CS. Two experienced readers masked to clinical information, imaging reports, independently reviewed F-FDG PET/CT images. F-FDG PET/CT images were interpreted according to a predefined standard operating procedure, with cardiac F-FDG uptake patterns categorized into 5 patterns: none, focal, focal on diffuse, diffuse, and isolated lateral wall or basal uptake. Overall image assessment was classified as either consistent with active CS or not. One hundred scans were included from 71 patients. Of these, 46 underwent F-FDG PET/CT with a no-restriction diet (no-restriction group), and 54 underwent F-FDG PET/CT with a low-carbohydrate, high-fat and protein-permitted diet (low-carb group). There was agreement of the interpretation category in 74 of 100 scans. The κ-value of agreement among all 5 categories was 0.64, indicating moderate agreement. For overall clinical interpretation, there was agreement in 93 of 100 scans (κ = 0.85). When scans were divided into the preparation groups, there was a trend toward higher agreement in the low-carb group versus the no-restriction group (80% vs. 67%, = 0.08). Regarding the overall clinical interpretation, there was also a trend toward greater agreement in the low-carb group versus the no-restriction group (96% vs. 89%, = 0.08). : The interobserver agreement of cardiac F-FDG uptake image patterns was moderate. However, agreement was better regarding overall interpretation of CS. Detailed prescan dietary preparation seemed to improve interobserver agreement.
最近的研究报告称，氟代脱氧葡萄糖正电子发射断层扫描（FDG PET）在辅助诊断和管理心脏结节病（CS）患者方面具有一定的作用。然而，FDG PET 对 CS 的图像解释有时具有挑战性。我们旨在研究观察者间和观察者内的一致性，并探讨导致读者之间出现重要差异的因素。
我们研究了连续就诊且无明显冠状动脉疾病的患者，这些患者因 CS 评估而被转诊。两名经验丰富的读者在不了解临床信息和影像学报告的情况下，独立地对 FDG PET/CT 图像进行了审查。FDG PET/CT 图像的解释遵循预定义的标准操作程序，根据心脏 FDG 摄取模式将其分为 5 种类型：无摄取、局灶性摄取、局灶性伴弥漫性摄取、弥漫性摄取以及孤立的侧壁或基底摄取。总体图像评估分为符合或不符合活动性 CS。
共纳入了 71 名患者的 100 次扫描。其中，46 例患者进行了无限制饮食的 FDG PET/CT（无限制组），54 例患者进行了低碳水化合物、高脂肪和高蛋白允许饮食的 FDG PET/CT（低碳组）。100 次扫描中有 74 次扫描的解释类别一致。所有 5 个类别的 κ 值为 0.64，表明一致性为中度。对于整体临床解释，100 次扫描中有 93 次扫描一致（κ=0.85）。当将扫描分为准备组时，低碳组的一致性趋势高于无限制组（80%比 67%，=0.08）。对于整体临床解释，低碳组的一致性也高于无限制组（96%比 89%，=0.08）。
心脏 FDG 摄取图像模式的观察者间一致性为中度。然而，CS 的整体解释的一致性更好。详细的预扫描饮食准备似乎可以提高观察者间的一致性。
