Kim Minjae, Lee Sang Min, Song Jae-Woo, Do Kyung-Hyun, Lee Hyun Joo, Lim Soyeoun, Choe Jooae, Park Kye Jin, Park Hyo Jung, Kim Hwa Jung, Seo Joon Beom
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43 Gil, Songpa-gu, 138-736 Seoul, Republic of Korea.
Department of Preventive Medicine, Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43 Gil, Songpa-gu, 138-736 Seoul, Republic of Korea; Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43 Gil, Songpa-gu, 138-736 Seoul, Republic of Korea.
Eur J Radiol. 2017 Jun;91:66-70. doi: 10.1016/j.ejrad.2017.03.018. Epub 2017 Mar 30.
To retrospectively investigate whether prone CT improves identification of honeycombing and classification of UIP patterns in terms of interobserver agreement and accuracy using pathological results as a reference standard.
Institutional review board approval with waiver of patients' informed consent requirement was obtained. HRCTs of 86 patients with pathologically proven UIP, NSIP and chronic HP between January 2011 and April 2015 were evaluated by 8 observers. Observers were asked to review supine only set and supine and prone combined set and determine the presence of honeycombing and UIP classification (UIP, possible UIP, inconsistent with UIP). The diagnosis was regarded as correct when UIP pattern on CT corresponded to pathological UIP.
Interobserver agreement of honeycombing identification among radiologists was only fair on the supine and combined set (weighted κ=0.31 and 0.34). Additional review of prone images demonstrated a significant improvement in interobserver agreement (weighted κ) of UIP classification from 0.25 to 0.33. Prone CT conferred a significant improvement in interobserver agreement of UIP classification for trainee radiologists (from 0.10 to 0.34) while no improvement was found for board-certified radiologists (from 0.35 to 0.31). There were no significant differences in the accuracy of UIP pattern with reference to pathological results between the supine and combined set (78.8% (145/184) and 81.3% (179/220), P=0.612).
Additional review of prone CT can improve overall interobserver agreement of UIP classification among radiologists with variable experiences, particularly for less experienced radiologists, while no improvement was found in honeycombing identification.
以病理结果作为参考标准，回顾性研究俯卧位CT在观察者间一致性和准确性方面是否能改善蜂窝状改变的识别及UIP模式的分类。
获得机构审查委员会批准并豁免患者知情同意要求。2011年1月至2015年4月间86例经病理证实为UIP、NSIP和慢性HP的患者的HRCT由8名观察者进行评估。观察者被要求仅回顾仰卧位图像集以及仰卧位和俯卧位联合图像集，并确定是否存在蜂窝状改变及UIP分类（UIP、可能的UIP、与UIP不一致）。当CT上的UIP模式与病理UIP相符时，诊断被视为正确。
放射科医生在仰卧位和联合图像集上对蜂窝状改变识别的观察者间一致性仅为中等（加权κ分别为0.31和0.34）。对俯卧位图像的额外回顾显示，UIP分类的观察者间一致性（加权κ）从0.25显著提高到0.33。俯卧位CT使实习放射科医生的UIP分类观察者间一致性有显著提高（从0.10提高到0.34），而对于获得委员会认证的放射科医生则未发现改善（从0.35降至0.31）。仰卧位和联合图像集在参照病理结果的UIP模式准确性方面无显著差异（分别为78.8%（145/184）和81.3%（179/220），P = 0.612）。
对俯卧位CT的额外回顾可提高不同经验放射科医生对UIP分类的总体观察者间一致性，特别是对于经验较少的放射科医生，而在蜂窝状改变的识别方面未发现改善。
