Back Susan J, Christopher Edgar J, Weiss Dana A, Oliver Edward R, Bellah Richard D, Darge Kassa
Division of Body Imaging, Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
Division of Urology, Department of Surgery, Children's Hospital of Philadelphia Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Pediatr Radiol. 2018 Oct;48(11):1606-1611. doi: 10.1007/s00247-018-4173-1. Epub 2018 Jun 20.
A multidisciplinary urinary tract dilation (UTD) classification system was published in 2014 to standardize definitions and renal/bladder ultrasound image interpretation.
To evaluate intra- and inter-rater reliability of this system on postnatal RBUS.
Renal/bladder US of 60 infants (<12 months) with urinary tract dilation were anonymized, retrospectively reviewed and scored twice using the UTD classification system by a pediatric urologist and four pediatric radiologists. Exams included supine and prone images of each kidney. Raters recorded the anterior posterior renal pelvis diameter in each position; and when present calyceal dilation (central and peripheral), ureteral dilation, parenchymal and bladder abnormalities. A UTD score was given to each kidney based on these components.
Intraclass correlation (ICC) of anterior posterior renal pelvis diameter measures was 0.99 (P<0.001). Intra-rater reliability for the anterior posterior renal pelvis diameter of each kidney was high, with ICC >0.95 (P<0.001). Inter-rater kappa values for UTD scores of both kidneys ranged from 0.60 to 0.77 (P <0.001). Intra-rater kappa values for UTD scores of both kidneys ranged from 0.74 to 0.92 (P <0.001). Of the six categories comprising the UTD score, discrepancy between raters was highest for interpretation of central and peripheral calyceal dilation.
Present inter- and intra-rater reliability findings were similar to those previously reported for grading systems for urinary tract dilation. Across these studies, kappa values are generally lower than the 0.8 cut-off advocated for medical measures. Here, calyceal dilation commonly determined the kidney UTD score and was also the source of greatest discrepancy between raters. Improving consistency of calyceal dilation interpretation may improve UTD consensus score reliability.
2014年发布了一个多学科泌尿道扩张（UTD）分类系统，以规范定义及肾脏/膀胱超声图像解读。
评估该系统在产后肾脏膀胱超声（RBUS）检查中的评分者内及评分者间可靠性。
对60例患有泌尿道扩张的婴儿（小于12个月）的肾脏/膀胱超声检查进行匿名处理，由一名儿科泌尿科医生和四名儿科放射科医生使用UTD分类系统进行回顾性审查并评分两次。检查包括每个肾脏的仰卧位和俯卧位图像。评分者记录每个位置的肾窦前后径；以及出现肾盂扩张（中央和外周）、输尿管扩张、实质和膀胱异常的情况。根据这些指标为每个肾脏给出一个UTD评分。
肾窦前后径测量的组内相关系数（ICC）为0.99（P<0.001）。每个肾脏肾窦前后径的评分者内可靠性较高，ICC>0.95（P<0.001）。两个肾脏UTD评分的评分者间kappa值范围为0.60至0.77（P<0.001）。两个肾脏UTD评分的评分者内kappa值范围为0.74至0.92（P<0.001）。在构成UTD评分的六个类别中，评分者之间在中央和外周肾盂扩张的解读上差异最大。
目前评分者间及评分者内的可靠性结果与先前报道的泌尿道扩张分级系统的结果相似。在这些研究中，kappa值通常低于医学测量所倡导的0.8临界值。在这里，肾盂扩张通常决定肾脏UTD评分，也是评分者之间差异最大的来源。提高肾盂扩张解读的一致性可能会提高UTD共识评分的可靠性。
