Lodeiro Gustav, Bokwa-Dąbrowska Katarzyna, Miron Andreia, Szaro Pawel
Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Musculoskeletal Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
Eur J Radiol Open. 2024 Jul 13;13:100590. doi: 10.1016/j.ejro.2024.100590. eCollection 2024 Dec.
Diffusion-weighted imaging (DWI) is widely used in neuroradiology or abdominal imaging but not yet implemented in the diagnosis of musculoskeletal tumors.
This study aimed to evaluate how including diffusion imaging in the MRI protocol for patients with musculoskeletal tumors affects the agreement between radiologists and non-radiologist.
Thirty-nine patients with musculoskeletal tumors (Ewing sarcoma, osteosarcoma, and benign tumors) consulted at our institution were included. Three raters with different experience levels evaluated examinations blinded to all clinical data. The final diagnosis was determined by consensus. MRI examinations were split into 1) conventional sequences and 2) conventional sequences combined with DWI. We evaluated the presence or absence of diffusion restriction, solid nature, necrosis, deep localization, and diameter >4 cm as known radiological markers of malignancy. Agreement between raters was evaluated using Gwet's AC1 coefficients and interpreted according to Landis and Koch.
The lowest agreement was for diffusion restriction in both groups of raters. Agreement among all raters ranged from 0.51 to 0.945, indicating moderate to almost perfect agreement, and 0.772-0.965 among only radiologists indicating substantial to almost perfect agreement.
The agreement in evaluating diffusion-weighted MRI sequences was lower than that for conventional MRI sequences, both among radiologists and non-radiologist and among radiologists alone. This indicates that assessing diffusion imaging is more challenging, and experience may impact the agreement.
扩散加权成像（DWI）在神经放射学或腹部成像中广泛应用，但尚未用于肌肉骨骼肿瘤的诊断。
本研究旨在评估在肌肉骨骼肿瘤患者的MRI检查方案中加入扩散成像如何影响放射科医生与非放射科医生之间的一致性。
纳入在我院就诊的39例肌肉骨骼肿瘤患者（尤文肉瘤、骨肉瘤和良性肿瘤）。三名经验水平不同的评估者在对所有临床资料不知情的情况下对检查进行评估。最终诊断通过共识确定。MRI检查分为1）传统序列和2）传统序列联合DWI。我们评估了扩散受限、实性特征、坏死、深部定位以及直径>4 cm等已知的恶性肿瘤放射学标志物的有无。使用Gwet's AC1系数评估评估者之间的一致性，并根据Landis和Koch进行解释。
两组评估者中，扩散受限的一致性最低。所有评估者之间的一致性范围为0.51至0.945，表明为中度至几乎完美的一致性，仅放射科医生之间的一致性为0.772 - 0.965，表明为实质性至几乎完美的一致性。
无论是在放射科医生与非放射科医生之间，还是仅在放射科医生之间，评估扩散加权MRI序列的一致性均低于传统MRI序列。这表明评估扩散成像更具挑战性，经验可能会影响一致性。
