Dalen Viktor, Vegsgaard Olsen Anne-Sofie, Jerome Claude-Pierre, Geitung Jonn-Terje, Dahm Anders E A
Medical Faculty, University of Oslo.
Department of Radiology, Akershus University Hospital, Lørenskog.
Hematol Rep. 2021 Oct 4;13(3):9037. doi: 10.4081/hr.2021.9037. eCollection 2021 Sep 6.
Skeletal disease is common in multiple myeloma. We investigated the inter-observer agreement and diagnostic accuracy of spinal fractures diagnosed by computer tomography (CT) and magnetic resonance imaging (MRI) from 12 myeloma patients. Two radiologists independently assessed the images. CT, MRI, and other images were combined to a gold standard. The inter-observer agreement was assessed with Cohen's kappa. Radiologist 1 diagnosed 20 malignant spinal fractures on CT and 26 on MRI, while radiologist 2 diagnosed 12 malignant spinal fractures on CT and 22 on MRI. In comparison the gold standard diagnosed 10 malignant spinal fractures. The sensitivity for malignant fractures varied from 0.5 to 1 for CT and MRI, and the specificity varied from 0.17 to 0.67. On MRI, the specificity for malignant spinal fractures was 0.17 for both radiologists. The inter-observer agreement for malignant spinal fractures on CT was -0.42 (Cohen's kappa) and -0.13 for MRI, while for osteoporotic fractures it was -0.24 for CT and 0.53 for MRI. We conclude that malignant spinal fractures were over-diagnosed on CT and MRI. The inter-observer agreement was extremely poor.
骨骼疾病在多发性骨髓瘤中很常见。我们调查了12例骨髓瘤患者经计算机断层扫描（CT）和磁共振成像（MRI）诊断的脊柱骨折的观察者间一致性和诊断准确性。两位放射科医生独立评估图像。将CT、MRI及其他图像合并作为金标准。用Cohen's kappa评估观察者间一致性。放射科医生1在CT上诊断出20例恶性脊柱骨折，在MRI上诊断出26例；而放射科医生2在CT上诊断出12例恶性脊柱骨折，在MRI上诊断出22例。相比之下，金标准诊断出10例恶性脊柱骨折。CT和MRI对恶性骨折的敏感性在0.5至1之间，特异性在0.17至0.67之间。在MRI上，两位放射科医生对恶性脊柱骨折的特异性均为0.17。CT上恶性脊柱骨折的观察者间一致性为-0.42（Cohen's kappa），MRI上为-0.13；而骨质疏松性骨折在CT上为-0.24，在MRI上为0.53。我们得出结论，CT和MRI对恶性脊柱骨折存在过度诊断。观察者间一致性非常差。
