BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA.
Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA.
Eur Radiol. 2022 Jan;32(1):533-541. doi: 10.1007/s00330-021-08163-7. Epub 2021 Jul 16.
To compare the diagnostic accuracy of generalist radiologists working in a community setting against abdominal radiologists working in an academic setting for the interpretation of MR when diagnosing acute appendicitis among emergency department patients.
This observational study examined MR image interpretation (non-contrast MR with diffusion-weighted imaging and intravenous contrast-enhanced MR) from a prospectively enrolled cohort at an academic hospital over 18 months. Eligible patients had an abdominopelvic CT ordered to evaluate for appendicitis and were > 11 years old. The reference standard was a combination of surgery and pathology results, phone follow-up, and chart review. Six radiologists blinded to clinical information, three each from community and academic practices, independently interpreted MR and CT images in random order. We calculated test characteristics for both individual and group (consensus) diagnostic accuracy then performed Chi-square tests to identify any differences between the subgroups.
Analysis included 198 patients (114 women) with a mean age of 31.6 years and an appendicitis prevalence of 32.3%. For generalist radiologists, the sensitivity and specificity (95% confidence interval) were 93.8% (84.6-98.0%) and 88.8% (82.2-93.2%) for MR and 96.9% (88.7-99.8%) and 91.8% (85.8-95.5%) for CT. For fellowship-trained radiologists, the sensitivity and specificity were 96.9% (88.2-99.5%) and 89.6% (82.8-94%) for MR and 98.4% (90.5-99.9%) and 93.3% (87.3-96.7%) for CT. No statistically significant differences were detected between radiologist groups (p = 1.0, p = 0.53, respectively) or when comparing MR to CT (p = 0.21, p = 0.17, respectively).
MR is a reliable, radiation-free imaging alternative to CT for the evaluation of appendicitis in community-based generalist radiology practices.
• There was no significant difference in MR image interpretation accuracy between generalist and abdominal fellowship-trained radiologists when evaluating sensitivity (p = 1.0) and specificity (p = 0.53). • There was no significant difference in accuracy comparing MR to CT imaging for diagnosing appendicitis for either sensitivity (p = 0.21) or specificity (p = 0.17). • With experience, generalist radiologists enhanced their MR interpretation accuracy as demonstrated by improved interpretation sensitivity (OR 2.89 CI 1.44-5.77, p = 0.003) and decreased mean interpretation time (5 to 3.89 min).
比较在社区环境中工作的通科放射科医生和在学术环境中工作的腹部放射科医生在诊断急诊科患者急性阑尾炎时对磁共振（MR）的诊断准确性。
本观察性研究对 18 个月内在学术医院前瞻性纳入的队列的 MR 图像进行了检查（非对比 MR 加弥散加权成像和静脉对比增强 MR）。符合条件的患者接受了腹盆 CT 检查以评估阑尾炎，且年龄> 11 岁。参考标准是手术和病理结果、电话随访和病历回顾的组合。6 名放射科医生对临床信息进行了盲法评估，分别来自社区和学术实践，独立地随机顺序解读 MR 和 CT 图像。我们计算了个体和组（共识）诊断准确性的测试特征，然后进行卡方检验以确定亚组之间的任何差异。
分析纳入了 198 名患者（114 名女性），平均年龄为 31.6 岁，阑尾炎患病率为 32.3%。对于通科放射科医生，MR 的敏感性和特异性（95%置信区间）分别为 93.8%（84.6-98.0%）和 88.8%（82.2-93.2%），CT 为 96.9%（88.7-99.8%）和 91.8%（85.8-95.5%）。对于 fellowship 培训的放射科医生，MR 的敏感性和特异性分别为 96.9%（88.2-99.5%）和 89.6%（82.8-94%），CT 为 98.4%（90.5-99.9%）和 93.3%（87.3-96.7%）。放射科医生组之间（p = 1.0，p = 0.53）或 MR 与 CT 之间（p = 0.21，p = 0.17）均未检测到统计学上的显著差异。
MR 是一种可靠的、无辐射的替代 CT 成像方法，可用于社区为基础的通科放射科医生对阑尾炎的评估。
在评估敏感性（p = 1.0）和特异性（p = 0.53）时，通科和腹部放射科医生之间的 MR 图像解读准确性没有显著差异。
对于诊断阑尾炎，MR 与 CT 成像的准确性比较，无论是敏感性（p = 0.21）还是特异性（p = 0.17）均无显著差异。
随着经验的积累，通科放射科医生提高了他们的 MR 解读准确性，表现为解读敏感性的提高（比值比 2.89，置信区间 1.44-5.77，p = 0.003）和平均解读时间的缩短（从 5 分钟到 3.89 分钟）。
