Einarsdóttir Hrefna Sæunn, Berg Ronan Martin Griffin, Borgwardt Lise
Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.
Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2100 Copenhagen, Denmark.
Diagnostics (Basel). 2020 Dec 17;10(12):1101. doi: 10.3390/diagnostics10121101.
Tc-dimercaptosuccinic acid (DMSA) scintigraphy is currently the method of choice for assessing renal scarring in children, but it is not established whether conducting the scan as a single photon emission tomography combined with low-dose CT (SPECT/ldCT) scan provides additional diagnostic benefits when compared to conventional planar scintigraphy. In the present study, we evaluated the interrater reliability of DMSA SPECT/ldCT vs. planar DMSA scintigraphy for diagnosing renal scarring.
Two nuclear medicine physicians blinded to patient data retrospectively analysed all paediatric Tc-DMSA scintigraphes that were conducted in our department for the assessment of post pyelonephritis renal scarring between 2011 and 2016. All scintigraphies included both a planar scan and SPECT/ldCT, and were performed on either a Phillips Precedence 16 slice CT or a Siemens Symbia 16 slice CT. The readers were blinded to each other's readings and to patient data, and assessed all scans dichotomously for evidence of renal scarring. For each scan, the readers further noted if they were confident in their interpretation.
A total of 46 pairs of planar SPECT/ldCT DMSA scans were included. The readers were unconfident about their interpretation of 40% of the planar scans and 5% of the SPECT/ldCT scans. The interrater agreement rate was 72% for planar scans and 91% for SPECT/ldCT, and the corresponding Cohen's kappa values were 0.38 and 0.79.
DMSA SPECT/ldCT is associated with higher reader confidence and interrater reliability than conventional planar DMSA scintigraphy for the assessment of post pyelonephritis renal scarring in children.
锝-二巯基丁二酸（DMSA）闪烁扫描术目前是评估儿童肾瘢痕的首选方法，但与传统平面闪烁扫描相比，单光子发射断层扫描结合低剂量CT（SPECT/ldCT）扫描是否能提供额外的诊断益处尚未明确。在本研究中，我们评估了DMSA SPECT/ldCT与平面DMSA闪烁扫描术在诊断肾瘢痕方面的评分者间可靠性。
两名对患者数据不知情的核医学医师回顾性分析了2011年至2016年在我院进行的所有用于评估肾盂肾炎后肾瘢痕的儿科锝-DMSA闪烁扫描。所有闪烁扫描均包括平面扫描和SPECT/ldCT，且在飞利浦Precedence 16层CT或西门子Symbia 16层CT上进行。阅读者对彼此的读数和患者数据不知情，并对所有扫描进行二分法评估以寻找肾瘢痕的证据。对于每次扫描，阅读者还需注明他们对自己的解读是否有信心。
共纳入46对平面SPECT/ldCT DMSA扫描。阅读者对40%的平面扫描和5%的SPECT/ldCT扫描的解读缺乏信心。平面扫描的评分者间一致率为72%，SPECT/ldCT为91%，相应的科恩kappa值分别为0.38和0.79。
对于评估儿童肾盂肾炎后肾瘢痕，DMSA SPECT/ldCT比传统平面DMSA闪烁扫描术具有更高的阅读者信心和评分者间可靠性。
