胃癌CT测量一致性的研究  

Intra-observer Agreement of Gastric Cancer Measurements on Contrast-enhanced Spiral CT

作　　者：迟永堃[1] 唐磊[1] 陈颖[1] 李艳玲[1] 孙应实[1] 张晓鹏[1] 

机构地区：[1]北京大学临床肿瘤学院,北京肿瘤医院暨北京市肿瘤防治研究所医学影像科,恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142

出　　处：《当代医学》2010年第8期22-27,共6页Contemporary Medicine

摘　　要：目的评价不同测量者间观察同一胃癌CT征象时,观察与测量相关参数的一致性水平,并探讨造成组间测量差异的原因。方法选取接受腹部增强CT检查的胃癌初诊病人50例(男性36例,女性14例;年龄22～79岁,平均年龄57.72岁)。两名医师采用独立盲法进行图像复阅并测量。记录胃癌癌肿的厚度、浆膜浸润情况、最大层面癌肿范围、癌肿强化方式及门脉期CT值。采用kappa检验、Blandand Altman法及Spearman相关系数评价两位阅片者间测量的一致性。结果在胃癌癌肿CT测量的五个参数中,仅有判断是否存在浆膜浸润的一致性相对较高,两位阅片者的Kappa值为0.735,为高度一致性。其余参数的测量一致性为差～中度,癌肿厚度、范围、强化方式及门脉期CT值的测量kappa值分别为:0.497、0.245、0.199、0.153。癌肿厚度、范围及门脉期CT值的平均差分别为-1.2mm,-11.2mm,0.1HU;95%的一致性限度分别为-8.4mm～6.0mm,-63.8mm～41.3mm,-54.6HU～54.9HU。Spearman相关系数分别为0.736,0.785,0.388。结论螺旋CT对判断胃癌浆膜侵犯的一致性相对较高,优于其他参数的测量与判断。Objective To determine the intra-observer agreement of gastric cancer measurements using contrast-enhanced spiral CT. Methods Fifty patients （36 males and 14 females） with histological proven gastric adenocarcinoma were examined by singleslice spiral CT. Two independent observers recorded the serosal invasion, thick and length of the tumor, contrast type and CT value on portal period. Intra-observer measurement agreement was assessed for each of the four parameters using the kappa analysis, Bland- Altman plots and Spearman correlation coefficients. Results The kappa values were 0.735, 0.497, 0.245, 0.199 and 0.153 for serosal invasion, thick and length of the tumor, contrast type and CT value on portal period respectively. Intra-observer agreement was good for serosal invasion, moderate for thick of the tumor, fair for length, poor for contrast type and CT value .For the thick and length of the tumor as well as CT value on portal period, the mean difference （95% limits of agreement） was -1.2（-8.4-6.0）mm, -11.2（-63.8-41.3） rnm, 0.1（-54.6-54.9）HU; with the Spearman correlation,coefficients of 0.736,0.785 and 0.388 respectively. Conclusion There is better Intra-observer agreement for serosal invasion than any other parameter on contrastenhanced spiral CT.

关 键 词：增强螺旋CT 胃癌 观察者间 一致性 

分 类 号：R735.2[医药卫生—肿瘤]