Scarpa Erica Cristina, Lyra João C, Lourenção Pedro L T de A, Hachem Andréa S, Silva Geraldo H S da, Giacóia Glauce R F, Ortolan Erika V P, Silva Camila de Paula, Silveira Guilherme L da, Bentlin Maria R
Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu, Departamento de Pediatria, Divisão de Neonatologia, São Paulo, SP, Brazil.
Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu, Departamento de Pediatria, Divisão de Neonatologia, São Paulo, SP, Brazil.
J Pediatr (Rio J). 2025 Jan-Feb;101(1):103-109. doi: 10.1016/j.jped.2024.07.008. Epub 2024 Aug 21.
The analysis of abdominal radiography is essential for the diagnosis and management of necrotizing enterocolitis (NEC) in newborns (NB). Studies, however, show a lack of agreement among physicians in the interpretation of images. This study aims to evaluate the agreement in the radiological interpretation of the NEC between examiners from different specialties (interexaminer analysis) and between the same examiner at different times (intraexaminer analysis).
Cross-sectional study for concordance analysis using plain radiographs of the abdomen of NB with suspected or confirmed NEC. The study included two neonatologists (Neo), two surgeons (SU), and two radiologists (RD). The participants filled out a form with questions about the radiographic findings; regarding the presence of intestinal loop distension, the specialists answered subjectively (yes or no) and objectively (calculation of the ratio between loop diameter and lumbar vertebrae measurements). Kappa coefficients were calculated for agreement analysis.
A total of 90 radiological images were analyzed. For the interexaminer evaluation, the agreement was low (kappa<0.4) in 30 % of the answers (Neo versus SU), 38 % (Neo versus RD), and 46 % (SU versus RD). In the intraexaminer evaluation, the neonatologist and the surgeon presented substantial or almost perfect agreement in 92 % of the answers, and the radiologist in 77 %. In the evaluation of intestinal loop distention, the greatest agreement between the specialties occurred when done objectively.
The results confirmed the low intra- and interexaminer agreement in the radiological analysis of the NEC, reinforcing the importance of standardizing the methods of radiological interpretation of the disease.
腹部X线摄影分析对于新生儿坏死性小肠结肠炎（NEC）的诊断和管理至关重要。然而，研究表明医生在图像解读方面缺乏一致性。本研究旨在评估不同专业的检查者之间（检查者间分析）以及同一检查者在不同时间之间（检查者内分析）对NEC进行放射学解读的一致性。
采用横断面研究进行一致性分析，使用疑似或确诊NEC的新生儿腹部平片。该研究包括两名新生儿科医生（Neo）、两名外科医生（SU）和两名放射科医生（RD）。参与者填写一份关于X线摄影结果的问题表格；关于肠袢扩张的情况，专家们进行主观回答（是或否）以及客观回答（计算肠袢直径与腰椎测量值之间的比率）。计算kappa系数用于一致性分析。
共分析了90张放射学图像。对于检查者间评估，在30%的答案中一致性较低（kappa<0.4）（新生儿科医生与外科医生之间），38%（新生儿科医生与放射科医生之间），以及46%（外科医生与放射科医生之间）。在检查者内评估中，新生儿科医生和外科医生在92%的答案中表现出高度或几乎完美的一致性，放射科医生为77%。在肠袢扩张评估中，各专业之间在客观评估时一致性最高。
结果证实了在NEC放射学分析中检查者内和检查者间的一致性较低，这凸显了规范该疾病放射学解读方法的重要性。
