De Luca Francesca, Finnbogason Thröstur, Kvist Ola
Department of Clinical Neuroscience, Karolinska Institute, Tomtebodavägen 18 a, 171 77 Stockholm, Sweden.
Department of Radiology, Karolinska University Hospital, Eugeniavägen 3, 171 64, Stockholm, Sweden.
BJR Open. 2024 Apr 10;6(1):tzae008. doi: 10.1093/bjro/tzae008. eCollection 2024 Jan.
MRI is an emerging imaging modality to assess skeletal maturity. This study aimed to chart the learning curves of paediatric radiologists when using an unfamiliar MRI grading system of skeletal maturity and to assess the clinical feasibility of implementing said system.
958 healthy paediatric volunteers were prospectively included in a dual-facility study. Each subject underwent a conventional MRI scan at 1.5 T. To perform the image reading, the participants were grouped into five subsets (subsets 1-5) of equal size (∼192) in chronological order for scan acquisition. Two paediatric radiologists (R1-2) with different levels of MRI experience, both of whom were previously unfamiliar with the study's MRI grading system, independently evaluated the subsets to assess skeletal maturity in five different growth plate locations. Congruent cases at blinded reading established the consensus reading. For discrepant cases, the consensus reading was obtained through an unblinded reading by a third paediatric radiologist (R3), also unfamiliar with the MRI grading system. Further, R1 performed a second blinded image reading for all included subjects with a memory wash-out of 180 days. Weighted Cohen kappa was used to assess interreader reliability (R1 vs consensus; R2 vs consensus) at non-cumulative and cumulative time points, as well as interreader (R1 vs R2) and intrareader (R1 vs R1) reliability at non-cumulative time points.
Mean weighted Cohen kappa values for each pair of blinded readers compared to consensus reading (interreader reliability, R1-2 vs consensus) were ≥0.85, showing a strong to almost perfect interreader agreement at both non-cumulative and cumulative time points and in all growth plate locations. Weighted Cohen kappa values for interreader (R1 vs R2) and intrareader reliability (R1 vs R1) were ≥0.72 at non-cumulative time points, with values ≥0.82 at subset 5.
Paediatric radiologists' clinical confidence when introduced to a new MRI grading system for skeletal maturity was high from the outset of their learning curve, despite the radiologists' varying levels of work experience with MRI assessment. The MRI grading system for skeletal maturity investigated in this study is a robust clinical method when used by paediatric radiologists and can be used in clinical practice.
Radiologists with fellowship training in paediatric radiology experienced no learning curve progress when introduced to a new MRI grading system for skeletal maturity and achieved desirable agreement from the first time point of the learning curve. The robustness of the investigated MRI grading system was not affected by the earlier different levels of MRI experience among the readers.
磁共振成像（MRI）是一种新兴的用于评估骨骼成熟度的成像方式。本研究旨在描绘儿科放射科医生在使用不熟悉的骨骼成熟度MRI分级系统时的学习曲线，并评估实施该系统的临床可行性。
958名健康儿科志愿者被前瞻性纳入一项双机构研究。每位受试者均接受了1.5T的常规MRI扫描。为了进行图像解读，参与者按扫描采集的时间顺序被等分为五个子集（子集1 - 5，每组约192例）。两名具有不同MRI经验水平且此前均不熟悉该研究的MRI分级系统的儿科放射科医生（R1 - 2）独立评估这些子集，以评估五个不同生长板位置的骨骼成熟度。在盲法阅片时一致的病例确定为共识阅片结果。对于存在差异的病例，由同样不熟悉MRI分级系统的第三位儿科放射科医生（R3）进行非盲法阅片以获得共识阅片结果。此外，R1对所有纳入的受试者进行了第二次盲法图像解读，间隔时间为180天以消除记忆影响。采用加权Cohen kappa系数在非累积和累积时间点评估阅片者间可靠性（R1与共识结果；R2与共识结果），以及在非累积时间点评估阅片者间（R1与R2）和阅片者内（R1与R1）可靠性。
与共识阅片相比，每对盲法阅片者的平均加权Cohen kappa值（阅片者间可靠性：R1 - 2与共识结果）均≥0.85，表示在非累积和累积时间点以及所有生长板位置均有很强到几乎完美的阅片者间一致性。在非累积时间点，阅片者间（R1与R2）和阅片者内可靠性（R1与R1）的加权Cohen kappa值≥0.72，在子集5时该值≥0.82。
尽管儿科放射科医生在MRI评估方面的工作经验水平不同，但在引入用于骨骼成熟度的新MRI分级系统时，他们从学习曲线的一开始临床信心就很高。本研究中所研究的用于骨骼成熟度的MRI分级系统，儿科放射科医生使用时是一种可靠的临床方法，可用于临床实践。
接受儿科放射学 fellowship培训的放射科医生在引入用于骨骼成熟度的新MRI分级系统时未经历学习曲线进展，并且从学习曲线的第一个时间点就达成了理想的一致性。所研究的MRI分级系统的可靠性不受阅片者早期不同MRI经验水平的影响。
