Likert Scale计分系统在MRI诊断侵犯性前置胎盘中的效能研究  

Evaluation of diagnostic performance of a MRI-based Likert scale's scoring system for invasive placenta previa

作　　者：孟砺实 杨正强[1] 陈婷[1] 王小宁[1] 洪汛宁[1] 

机构地区：[1]南京医科大学第一附属医院介入放射科,江苏南京210029 [2]江苏省镇江市第四人民医院影像科,江苏镇江212001

出　　处：《医学影像学杂志》2017年第7期1350-1355,共6页Journal of Medical Imaging

基　　金：江苏省卫生厅面上项目(编号:H201401)

摘　　要：目的评价Likert Scale(李克特量表)计分系统在MRI诊断侵犯性前置胎盘中的效能。方法回顾分析104例经产前MRI检查及术中诊断为前置胎盘孕妇的MRI图像,其中有胎盘侵犯59例,均经过临床手术及病理证实。Likert Scale计分系统是根据李克特五分量表对侵犯性前置胎盘7个MRI征象(胎盘信号不均、胎盘内条状低信号带、胎盘内异常血管、子宫肌层增多增粗血管、胎盘内外缘局部隆起、胎盘处子宫肌层模糊不清、胎盘向宫颈内口突出)进行评分,然后计算7个MRI征象评分的总分。A、B两名阅片医师对104例前置胎盘MRI图像按照Likert Scale计分系统进行评分,两名阅片医师读片一致性采用组内相关系数(intraclass correlation coefficients,ICC)衡量;诊断效能通过受试者工作特征(receiver operator characteristic,ROC)曲线分析。结果两名阅片医师在总分及各分项MRI征象评分一致性均表现较好(ICC≥0.60),可以取两名阅片医师总分及每个MRI征象评分的均值绘制诊断侵犯性前置胎盘的ROC曲线;总分、各分项MRI征象ROC曲线下面积以及各分项MRI征象ROC曲线下面积与总分进行比较,结果如下:总分(0.983)、胎盘信号不均(0.888,P=0.003)、胎盘内条状低信号带(0.918,P=0.005)、胎盘内异常血管(0.850,P=0.000)、子宫肌层增多增粗血管(0.850,P=0.000)、胎盘内外缘局部隆起(0.852,P=0.000)、胎盘处子宫肌层模糊不清(0.880,P=0.002)、胎盘向宫颈内口突出(0.747,P=0.000)。总分的ROC曲线下面积大于各分项MRI征象,差别有统计学意义(P<0.05),表明总分的诊断效能高于单个MRI征象评分。结论 Likert Scale计分系统在MRI诊断侵犯性前置胎盘中具有非常高的诊断效能。Objective To evaluate the diagnostic performance of a MRI-based Likert scale＇s scoring system for invasive placenta previa.Methods Prenatal MR images of 104 women were retrospectively evaluated, 59 of whom were diagnosed with invasive placenta.The seven MRI features of invasive placenta were heterogeneous placenta, dark band on T2-weighted images, intraplacental abnormal vascularity, myometrial abnormal vascularity, placental bulge, myometrial thinning and placental protrusion sign.The Likert scale＇s scoring system was defined as the sum of 5-point Likert scale scores for seven MRI features.Two experienced radiologists （readers A and B） calculated the cumulative score.Interobserver agreement was assessed by measuring the intraclass correlation coefficient （ICC）.Diagnostic performance was evaluated by means of receiver operating characteristic （ROC） analysis.Results Interobserver ageetment was good for the cumulative score and seven MRI features of invasive placenta （ICC≥0.60）, so the average imaging score of two readers was adapted into ROC analysis.The areas under the ROC curve for the cumulative score were higher than those of other MR features （cumulative score：0.983;heterogeneous placenta： 0.888, P=0.003;intraplacental T2 dark band： 0.918, P=0.005;intraplacental abnormal vascularity： 0.850, P=0.000;myometrial abnormal vascularity： 0.850, P=0.000;placental bulge： 0.852, P=0.000;myometrial thinning： 0.880, P=0.002;placental protrusion sign： 0.747, P=0.000）.Conclusion This MRI-based Likert scale＇s scoring system demonstrated good diagnostic performance for invasive placenta previa.

关 键 词：胎盘侵犯 磁共振成像 李克特量表 

分 类 号：R714.56[医药卫生—妇产科学] R445.2[医药卫生—临床医学]