Department of Radiology, University of California San Diego, 200 W. Arbor Drive #8756, San Diego, CA, 92103-8756, USA.
School of Medicine, University of California San Diego, La Jolla, CA, USA.
Abdom Radiol (NY). 2019 Jan;44(1):54-64. doi: 10.1007/s00261-018-1683-0.
The purpose of the study is to assess the reader agreement and accuracy of eight ultrasound imaging features for classifying hepatic steatosis in adults with known or suspected hepatic steatosis.
This was an IRB-approved, HIPAA-compliant prospective study of adult patients with known or suspected hepatic steatosis. All patients signed written informed consent. Ultrasound images (Siemens S3000, 6C1HD, and 4C1 transducers) were acquired by experienced sonographers following a standard protocol. Eight readers independently graded eight features and their overall impression of hepatic steatosis on ordinal scales using an electronic case report form. Duplicated images from the 6C1HD transducer were read twice to assess intra-reader agreement. Intra-reader, inter-transducer, and inter-reader agreement were assessed using intraclass correlation coefficients (ICC). Features with the highest intra-reader agreement were selected as predictors for dichotomized histological steatosis using Classification and Regression Tree (CART) analysis, and the accuracy of the decision rule was compared to the accuracy of the radiologists' overall impression.
45 patients (18 males, 27 females; mean age 56 ± 12 years) scanned from September 2015 to July 2016 were included. Mean intra-reader ICCs ranged from 0.430 to 0.777, inter-transducer ICCs ranged from 0.228 to 0.640, and inter-reader ICCs ranged from 0.014 to 0.561. The CART decision rule selected only large hepatic vein blurring and achieved similar accuracy to the overall impression (74% to 75% and 68% to 72%, respectively).
Large hepatic vein blurring, liver-kidney contrast, and overall impression provided the highest reader agreement. Large hepatic vein blurring may provide the highest classification accuracy for dichotomized grading of hepatic steatosis.
本研究旨在评估八项超声成像特征在诊断成人已知或疑似脂肪性肝病中的读者间一致性和准确性。
这是一项经机构审查委员会批准、符合 HIPAA 规定的前瞻性研究，纳入了患有已知或疑似脂肪性肝病的成年患者。所有患者均签署了书面知情同意书。超声图像（西门子 S3000、6C1HD 和 4C1 探头）由经验丰富的超声医师按照标准方案采集。八位读者独立使用电子病例报告表在有序量表上对八项特征及其对肝脏脂肪变性的整体印象进行分级。使用 6C1HD 探头重复采集的图像进行了两次读取，以评估读者内一致性。使用组内相关系数（ICC）评估读者内、探头间和读者间的一致性。使用分类回归树（CART）分析选择具有最高读者内一致性的特征作为组织学脂肪变性的二分类预测因子，并将决策规则的准确性与放射科医生整体印象的准确性进行比较。
2015 年 9 月至 2016 年 7 月期间纳入 45 名患者（男 18 名，女 27 名；平均年龄 56±12 岁）。读者内 ICC 均值范围为 0.430 至 0.777，探头间 ICC 均值范围为 0.228 至 0.640，读者间 ICC 均值范围为 0.014 至 0.561。CART 决策规则仅选择大肝静脉模糊，并与整体印象具有相似的准确性（分别为 74%至 75%和 68%至 72%）。
大肝静脉模糊、肝-肾对比和整体印象提供了最高的读者间一致性。大肝静脉模糊可能为肝脏脂肪变性的二分类分级提供最高的分类准确性。
