Wang Meng, Ma Qi, Chen Yang, Li Jie, Wang Cheng, Jin Yuma, Zhang Yingchun, Chen Hanbing, Liu Songtao, Wang Caishan, Sheng Yujing, Bai Xue, Zhang Ying, Lin Wenwen, Feng Xinyu
Department of Ultrasound, The Second Affiliated Hospital of Soochow University, Suzhou, China.
Department of Ultrasound, The Second Affiliated Hospital of Soochow University, Suzhou, China.
Urology. 2019 Apr;126:39-44. doi: 10.1016/j.urology.2019.01.021. Epub 2019 Feb 1.
To determine and evaluate the value of shadowing and the twinkling artifact (TA) for the diagnosis of ureteral stones.
Related ultrasound images from 117 patients with suspected ureteral stones were consecutively collected with optimized machine settings, confirmed by computed tomography and then retrospectively reviewed by 12 physicians who were classified into 3 groups according to their experience levels: elementary, intermediate, and advanced. The shadowing/TA grades were separately evaluated by all the participating physicians in a blinded manner, and the consistency was verified using Kendall's coefficient of concordance (Kendall's W). Furthermore, the diagnostic performance was compared among the groups stratified by physicians' clinical experience levels and ureteral stone sizes.
Using shadowing/TA as indicators for ureteral stones, Kendall's W for the TA evaluation was higher than that for shadowing among all the participating physicians and subgroups (P <.05). Furthermore, with no difference in specificity at 100%, the sensitivity of the isolated TA was superior to that of shadowing in groups stratified by the physicians' clinical experience levels and stone sizes, respectively (P <.05). However, for the respective comparisons of shadowing and the TA among groups stratified by stone sizes, as ureteral stones became larger, the detection sensitivities all significantly increased (P ≤.001).
Among physicians, subjective evaluation of the TA is more consistent and has better diagnostic sensitivity than that of shadowing for the diagnosis of ureteral stones, and the stone size may play an important role in the detection sensitivity of these 2 indicators.
确定并评估声影和闪烁伪像（TA）在输尿管结石诊断中的价值。
连续收集117例疑似输尿管结石患者的相关超声图像，采用优化的机器设置，经计算机断层扫描确认，然后由12名医生进行回顾性分析，这些医生根据经验水平分为3组：初级、中级和高级。所有参与的医生以盲法分别评估声影/TA分级，并使用肯德尔和谐系数（肯德尔W）验证一致性。此外，比较了按医生临床经验水平和输尿管结石大小分层的组间诊断性能。
以声影/TA作为输尿管结石的指标，在所有参与医生和亚组中，TA评估的肯德尔W高于声影评估的肯德尔W（P<.05）。此外，在特异性均为100%无差异的情况下，孤立TA的敏感性分别优于按医生临床经验水平和结石大小分层的组中的声影敏感性（P<.05）。然而，在按结石大小分层的组中，分别比较声影和TA时，随着输尿管结石变大，检测敏感性均显著增加（P≤.001）。
在医生中，对于输尿管结石的诊断，TA的主观评估比声影更具一致性且诊断敏感性更好，并且结石大小可能在这两个指标的检测敏感性中起重要作用。
