肺肿块轮廓特征辨识的观察者之间的一致性分析  

Inter-observer variation in CT diagnosis of edge characteristics of pulmonary mass

作　　者：王秋萍[1] 李艳[1] 牛刚[1] 张蕴[1] Sun Meng 强永乾[1] 闫锐[3] 郭佑民[1] 

机构地区：[1]西安交通大学医学院第一附属医院医学影像科,陕西西安710061 [2]Institute for Molecular and Cellular Regulation,Gunma University [3]西安交通大学医学院附属西安市中心医院影像中心

出　　处：《实用放射学杂志》2011年第8期1150-1153,1157,共5页Journal of Practical Radiology

基　　金：陕西省社发攻关项目（编号：2009K15-01）.

摘　　要：目的研究肺肿块CT毛刺征、分叶征辨识的个体间差异，确定在临床工作中这2种征象辨识的稳定性。方法5位不同工作经历的影像医师作为观察者，对经病理证实的49例肺肿块的CT图片进行评价，确定毛刺征、分叶的有无及其程度。使用7。检验和Kappa系数（K值）进行统计学研究。结果毛刺的总体检出率在5位观察者之间差异无统计学差异（检出率平均39．2o．4，范围：32．7％～54．1％；x2=24．892，df=4，P=0．213），对毛刺各亚型检出率的判断差异显著，有统计学意义（x2=46．6555，df=20，P=0．001[双尾]），K值从0．277（P=0．041）～0．738（P=0．000）不等。分叶征的有无及其亚型的辨识，5位观察者的总体检出率均存在统计学差异（x2=34．563，df=4，P=0．000和矿=93．323，df=16，P=0．000[双尾]），K值仅为0．036（P=0．342）～O．453（P=0．001）。结论肺肿块轮廓征象的主观判断、手工测量个体之间差异较大。Objective To assess the inter-observer variability in detecting the characteristics of burr sign and lobulated sign of lung nodules on CT. Methods CT images in 49 cases with pathologically proved solitary pulmonary masses were independently observed by five radiologists with different working experiences,including the CT signs of lobulated and burr of masses （malignant or benign）. The results were analyzed with x2 test and Kappa statistics （K value）. Results There were no statistically signifcant differences in the detecting rates of burr sign between observers （mean 39.2 %, range： 32.7% -54.1%;X2 = 24. 892, df=4, P = 0. 213 ）, but for the subtype of burr sign were of statistically significant differences between observers（x2 = 46.6555, d f= 20, P = 0. 001）, and K value from 0. 277 （P= 0. 041 ）to 0. 738 （P= 0. 000）. There were statistically signifcant difference in the detecting rates of lobulat- ed sign（ whether or not present and subtype） betwwen observers （x2 = 34. 563, df= 4, P = 0. 000 ; x2 = 93. 323, df= 16, P = 0. 000 ） , and K value from 0. 036（P=0. 342） to 0. 453（P=0. 001）. Conclusion inter-observer agreement in CT diagnosis of the contour characteristics of pulmonary nodules with subjective judgment is relatively low.

关 键 词：肺 孤立性肺肿块 体层摄影术 X线计算机 

分 类 号：R563[医药卫生—呼吸系统] R814.42[医药卫生—内科学]