Department of Radiology, Hôpital Saint-Joseph, 185 Rue Raymond Losserand, 75014, Paris, France.
Department of Medical Imaging, CHU Lapeyronie, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France.
Eur Radiol. 2019 May;29(5):2302-2310. doi: 10.1007/s00330-018-5906-0. Epub 2019 Jan 10.
To assess interobserver agreement when using the revised Atlanta classification (RAC) to categorize pancreatic and peripancreatic collections during the first month of acute pancreatitis (AP), and to correlate type of collection to outcome.
This retrospective study of 115 consecutive patients admitted for 123 AP episodes, 178 CTs performed within the first month showed peripancreatic abnormalities. Each AP episode was classified as mild, moderately severe, or severe based on the RAC. Two radiologists, blinded to clinical data, used RAC criteria to retrospectively categorize the collections as acute peripancreatic fluid collections (APFC) or acute necrotic collections (ANC). Interobserver agreement was assessed based on Cohen's κ statistics and compared according to CT timing.
Interobserver agreement for categorizing peripancreatic collections was moderate (κ = 0.45) and did not improve with time to CT (κ values, 0.53 < day 3, 0.34 on days 3-6, and 0.43 ≥ day 7). For detecting parenchymal necrosis, interobserver agreement was also moderate (κ = 0.45). AP was less severe in patients with APFC versus ANC (p = 0.04).
Our finding of moderate interobserver agreement when using the RAC to categorize pancreatic and peripancreatic collections by CT indicates that the accurate diagnosis of APFC or ANC by CT in the first 4 weeks after symptom onset is often challenging.
• Interobserver agreement was moderate for categorizing peripancreatic collections. • Interobserver agreement did not improve with time from onset to CT. • Interobserver agreement was moderate for detecting parenchymal necrosis.
评估在急性胰腺炎（AP）发病的第一个月内，使用修订的亚特兰大分类（RAC）对胰腺和胰周积液进行分类时的观察者间一致性，并将积液类型与结局相关联。
这是一项回顾性研究，共纳入 115 例连续因 123 例 AP 发作入院的患者，在发病的第一个月内共进行了 178 次 CT 检查，显示胰周异常。根据 RAC，每个 AP 发作均被分为轻度、中度重度或重度。两名放射科医生在不了解临床数据的情况下，使用 RAC 标准回顾性地将积液分类为急性胰周液体积聚（APFC）或急性坏死性积聚（ANC）。观察者间一致性基于 Cohen's κ 统计量进行评估，并根据 CT 时间进行比较。
胰周积液分类的观察者间一致性为中度（κ=0.45），且随着 CT 时间的延长而没有改善（κ 值分别为 3 天内为 0.53，3-6 天为 0.34，≥7 天为 0.43）。对于检测实质坏死，观察者间一致性也为中度（κ=0.45）。与 ANC 相比，APFC 患者的 AP 严重程度较轻（p=0.04）。
我们发现，在发病的第一个 4 周内，使用 RAC 通过 CT 对胰腺和胰周积液进行分类时，观察者间一致性为中度，这表明在症状出现后的前 4 周内，通过 CT 准确诊断 APFC 或 ANC 常常具有挑战性。
• 胰周积液分类的观察者间一致性为中度。• 从发病到 CT 的时间延长并未改善观察者间一致性。• 检测实质坏死的观察者间一致性为中度。
