Haseli Sara, Park Chankue, Azhideh Arash, Karande Gita, Chalian Majid
Department of Radiology, Division of Musculoskeletal Imaging and Intervention, University of Washington, Seattle, WA, USA.
OncoRad Research Core, Department of Radiology, University of Washington/Fred Hutchinson Cancer Center, Seattle, WA, USA.
Skeletal Radiol. 2025 Jan 22. doi: 10.1007/s00256-025-04865-x.
To propose a revised bone reporting and data system (Bone-RADS) and evaluate its diagnostic performance and inter-reader reliability compared to the original Bone-RADS for solitary bone lesions on CT.
This retrospective study included 159 adult patients (mean age: 56 ± 19 years; 88 men) who underwent bone biopsy for solitary bone lesions between March 2005 and September 2021. Two radiologists (R1/2) independently categorized the lesions twice, once using the original Bone-RADS and once using the revised version. Lesions were classified as follows: (1, benign; 2, incompletely assessed; 3, indeterminate; 4, malignancy or requiring treatment). The revised Bone-RADS excluded the original criteria for lesion related pain and history of malignancy. Diagnostic performance was assessed using histopathology as the reference standard, and inter-reader reliability was analyzed.
The bone lesions included 96 lucent and 63 sclerotic/mixed lesions. Sensitivity showed no significant difference between the original and revised Bone-RADS for both readers across lucent and sclerotic/mixed lesions (all P ≥ .05). However, the specificity of the revised Bone-RADS was significantly higher than that of the original (lucent: 11% vs. 50% [R1], 11% vs. 46% [R2]; sclerotic/mixed: 32% vs. 92% [R1], 32% vs. 86% [R2]). Other performance metrics, including positive/negative predictive value and accuracy, were also higher in the revised Bone-RADS. Inter-reader reliability was higher for the revised Bone-RADS compared to the original (κ = .744 vs .854).
The revised Bone-RADS significantly improved specificity while maintaining sensitivity compared to the original version.
提出一种修订后的骨报告与数据系统（Bone-RADS），并与用于CT上孤立性骨病变的原始Bone-RADS相比，评估其诊断性能和阅片者间的可靠性。
这项回顾性研究纳入了2005年3月至2021年9月期间因孤立性骨病变接受骨活检的159例成年患者（平均年龄：56±19岁；88例男性）。两名放射科医生（R1/2）对病变进行两次独立分类，一次使用原始Bone-RADS，一次使用修订版。病变分类如下：（1，良性；2，评估不完整；3，不确定；4，恶性或需要治疗）。修订后的Bone-RADS排除了与病变相关疼痛和恶性肿瘤病史的原始标准。以组织病理学作为参考标准评估诊断性能，并分析阅片者间的可靠性。
骨病变包括96例透亮性病变和63例硬化性/混合性病变。对于两位阅片者，在透亮性病变和硬化性/混合性病变中，原始版和修订版Bone-RADS的敏感性均无显著差异（所有P≥0.05）。然而，修订版Bone-RADS的特异性显著高于原始版（透亮性病变：R1为11%对50%，R2为11%对46%；硬化性/混合性病变：R1为32%对92%，R2为32%对86%）。修订版Bone-RADS的其他性能指标，包括阳性/阴性预测值和准确性，也更高。与原始版相比,修订版Bone-RADS的阅片者间可靠性更高（κ=0.744对0.854）。
与原始版相比，修订后的Bone-RADS在保持敏感性的同时显著提高了特异性。
