用 Kappa 统计量评估 CT 对腰椎间盘突出诊断的一致性

摘要

目的采用Kappa统计量评价CT诊断腰椎间盘突出症的一致性。方法回顾性分析120例患者的360个椎间盘的CT图像。由影像科A、B2名医师分别在有及无临床资料的情况下对其中60例患者进行2次评价，再在无临床资料的情况下共同对其中60例患者腰椎间盘进行评价。应用Kappa检验评价同一医生不同情况下和不同医生的诊断结果一致性。结果 A、B在无和有临床资料的情况下，两次诊断具有较高的一致性，其Kappa值分别为0．646和0×639。诊断差异主要出现于正常和膨出的鉴别，前后2次诊断膨出的差异达18个和26个，分别占不相符率的47．4％（18/38）和63．4％（26/41）。在有临床资料时，椎间盘膨出的诊断较无临床资料时分别多7个和26个。不同医生之间诊断具有中度一致性，其Kappa值为0．480。诊断差异仍然主要出现在正常和膨出的鉴别，二者之间诊断膨出的差异达37个，占不相符率的61．7％（37/60）。结论应用CT诊断腰椎间盘病变，不同医生之间的诊断一致性较差，并且有无临床资料会影响同一医生的诊断一致性，尤其是影响到腰椎间盘膨出的诊断。%Objective To assess the consistency of CT in the diagnosis of lumbar disc herniation by application of Kappa statistic.Methods 120 patients and 360 CT images of the intervertebral disc were retrospective analyzed.Two radiologists(doc-tor A and doctor B) evaluated the lumbar disks in 60 patients twice independently:once before and once after disclosure of clini-cal information.Anddisks of 60 patients out of the 120 samples were interpreted by the two radiologists independently without clinical information as well.The Kappa statistics was employed to assess the concordance of each radiologist′s diagnoses as well as the observer variation of the two radiologists .Results Doctor A and doctor B had a high consistency in twice diagnosis in case of clinical data and no clinical data, with the Kappa values of 0.646 and 0.639, respectively.The main difference on diagenoses happened on the differential diagnosis of normal disks and bulging disks.The different diagnoses of bulging disks made between with and without clinical information were 20 disks and 30 disks,which accounted for 47.4%(18/38) and 63.4%(26/41) of totsl variation, respectively.After disclosure to clinical information, the numbers of reported bulging disks increased significantly by 10 and 31, respectively.Diagnosis between the different doctors had moderate consistency, with Kappa value of 0.480.Diag-nostic differences are still mainly in the differential diagnosis of normal and bulging disks, with a difference of 37 bulging disks between the two doctors, which accounted for 61.7%(37/60) of totsl variation.Conclusion It shows poor diagnostic consis-tency between the different doctors using CT for diagnosis of lumbar disc disease, and the presence or absence of clinical data will affect the consistency of the same doctor's diagnosis, especially affecting the diagnosis of lumbar disc prolapse.