Gill Ritu R, Murphy David J, Seethamraju Ravi T, Mazzola Emanuele, Bueno Raphael, Richards William G
Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215-5491 (R.R.G.); Department of Radiology, St Vincent's University Hospital, Dublin, Ireland (D.J.M.); Magnetic Resonance Research & Development, Siemens Healthineers, Boston, Mass (R.T.S.); Division of Biostatistics, Department of Data Sciences, Dana Farber Cancer Institute, Boston, Mass (E.M.); and Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (R.B., W.G.R.).
Radiol Cardiothorac Imaging. 2020 Apr 30;2(2):e190066. doi: 10.1148/ryct.2020190066. eCollection 2020 Apr.
To evaluate the interobserver variability associated with quantitative and qualitative MRI assessments of malignant pleural mesothelioma (MPM).
Patients with MPM who underwent uniform-protocol preoperative MRI between 2009 and 2014 were included. The MRI-derived tumor volume was estimated. Unidimensional measurements of maximal pleural thickness ( ) and average pleural thickness ( ) on axial MR images; maximal fissural thickness ( ); maximal diaphragmatic thickness ( ); and average diaphragmatic thickness ( ) on sagittal reconstructed images were acquired. Interobserver agreement regarding the American Joint Committee on Cancer (AJCC) tumor stage at each criterion level was assessed by using Cohen κ statistics. Agreement between quantitative measurements was assessed by using Bland-Altman plots and intraclass correlation coefficients (ICCs).
The study cohort included 349 patients (median age, 68 years [age range, 30-90 years), 273 (78%) of whom were men and 203 (58%) of whom had epithelioid-subtype tumors. Qualitative assessment performed by using the AJCC staging criteria (eighth edition) was concordant in 31% of cases and yielded considerable disagreement (κ = 0.177). Inspection of the Bland-Altman plots led to decisive agreement between the two reviewers regarding MRI-derived tumor volume (ICC, 0.979). There was also a good degree of agreement between the two reviewers regarding unidimensional measurements of (ICC, 0.807), (ICC, 0.823), (ICC, 0.787), (ICC, 0.787), and (ICC, 0.659).
Quantitative assessment can enhance the clinical staging of MPM. Compared with qualitative assessment, quantitative assessment has low interobserver variability and could yield a tumor size criterion that is currently lacking in the AJCC clinical staging of MPM.© RSNA, 2020.
评估恶性胸膜间皮瘤（MPM）定量和定性MRI评估的观察者间变异性。
纳入2009年至2014年间接受统一方案术前MRI检查的MPM患者。估计MRI得出的肿瘤体积。获取轴位MR图像上最大胸膜厚度（ ）和平均胸膜厚度（ ）的一维测量值；矢状面重建图像上的最大叶间裂厚度（ ）、最大膈肌厚度（ ）和平均膈肌厚度（ ）。采用Cohen κ统计量评估各标准水平下美国癌症联合委员会（AJCC）肿瘤分期的观察者间一致性。通过Bland-Altman图和组内相关系数（ICC）评估定量测量之间的一致性。
研究队列包括349例患者（中位年龄68岁[年龄范围30 - 90岁]），其中273例（78%）为男性，203例（58%）为上皮样亚型肿瘤。采用AJCC分期标准（第八版）进行的定性评估在31%的病例中一致，且存在较大分歧（κ = 0.177）。对Bland-Altman图的检查显示，两位审阅者在MRI得出的肿瘤体积方面达成了决定性一致（ICC，0.979）。两位审阅者在 （ICC，0.807）、 （ICC，0.823）、 （ICC，0.787）、 （ICC，0.787）和 （ICC，0.659）的一维测量方面也有较好的一致性。
定量评估可提高MPM的临床分期。与定性评估相比，定量评估的观察者间变异性较低，并且可以得出目前AJCC MPM临床分期中缺乏的肿瘤大小标准。©RSNA，2020。
