Barkhof F, Filippi M, van Waesberghe J H, Molyneux P, Rovaris M, Lycklama à Nijeholt G, Tubridy N, Miller D H, Yousry T A, Radue E W, Adèr H J
Department of Diagnostic Radiology, Academic Hospital of the Vrije Universiteit, Amsterdam, The Netherlands.
Neurology. 1997 Dec;49(6):1682-8. doi: 10.1212/wnl.49.6.1682.
Gadolinium-enhanced MRI is a sensitive and objective means to monitor disease activity in multiple sclerosis (MS). We evaluated the interobserver agreement and the value of observer training in reporting enhancing lesions from serial MRI. Scans of 16 MS patients were evaluated by five inexperienced and five experienced observers before and after consensus formation and training. The number of lesions at baseline, and the number of new and persistent lesions at follow-up were scored. For each condition, weighted kappa values (kappa) and the mean average difference to the median (MADM) scores were calculated. Without training, the experienced readers showed good agreement on number of lesions at baseline and new lesions at follow-up, and moderate agreement for persistent lesions. The inexperienced readers showed poor agreement for baseline and persistent lesions, and moderate agreement for new lesions. After training, both groups reported lower absolute numbers of lesions, especially the inexperienced readers. The experienced readers showed good agreement for all lesion types, the inexperienced readers showed agreement for baseline and new lesions, and agreement was moderate for persistent lesions. In both groups MADM scores were < 0.72 for baseline and new lesions, but > 1.2 for persistent lesions. Interobserver agreement is improved by training, especially in inexperienced readers. Interobserver agreement in reporting gadolinium-enhanced lesions is high, which validates the use of serial, enhanced MRI as an outcome parameter in treatment trials in MS.
钆增强磁共振成像（MRI）是监测多发性硬化症（MS）疾病活动的一种敏感且客观的手段。我们评估了观察者间的一致性以及观察者培训在报告系列MRI增强病灶方面的价值。在形成共识和培训前后，由五名经验不足的观察者和五名经验丰富的观察者对16例MS患者的扫描结果进行评估。对基线时的病灶数量以及随访时新出现和持续存在的病灶数量进行评分。针对每种情况，计算加权kappa值（kappa）以及与中位数的平均平均差（MADM）分数。未经培训时，经验丰富的读者在基线病灶数量和随访时新病灶数量方面表现出良好的一致性，而在持续存在的病灶方面表现出中等一致性。经验不足的读者在基线和持续存在的病灶方面表现出较差的一致性，而在新病灶方面表现出中等一致性。培训后，两组报告的病灶绝对数量均有所降低，尤其是经验不足的读者。经验丰富的读者在所有病灶类型上都表现出良好的一致性，经验不足的读者在基线和新病灶方面表现出一致性，而在持续存在的病灶方面表现出中等一致性。两组在基线和新病灶方面的MADM分数均<0.72，但在持续存在的病灶方面>1.2。培训可提高观察者间的一致性，尤其是在经验不足的读者中。报告钆增强病灶时观察者间的一致性较高，这验证了在MS治疗试验中使用系列增强MRI作为结果参数的合理性。
