膝关节骨关节炎全关节磁共振成像评分观察者间一致性评价  

Inter-observer agreements of Whole-Organ Magnetic Resonance Imaging Score for assessing knee osteoarthritis

作　　者：徐黎[1] 李凯[1] 过哲[1] 王超[2] 程晓光[1] Xu Li;Li Kai;Guo Zhe;Wang Chao;Cheng Xiaoguang(Department of Radiology, Beijing Jishuitan Hospital, the Fourth Clinical Medical College of Peking University, Beijing 100035, China)

机构地区：[1]北京大学第四临床医学院北京积水潭医院放射科,100035 [2]北京市创伤骨科研究所流行病与卫生统计研究室

出　　处：《骨科临床与研究杂志》2021年第2期106-111,共6页Journal Of Clinical Orthopedics And Research

摘　　要：目的探讨应用全关节磁共振成像评分(WORMS)系统对膝关节各结构特征进行半定量评价的观察者间一致性以及观察者临床阅片经验对评分结果的影响。方法利用“祛风止痛胶囊对膝骨关节炎的临床作用及机制研究”临床研究项目数据库,随机抽取2018年5至10月摄取的膝关节骨关节炎患者的磁共振像(MRI)10例,分别由3位年资不同、拥有不同临床阅片经验并接受过膝关节WORMS评分系统培训的放射科医生应用WORMS评分对患者患膝MRI进行评价。以其中1位高年资并具备MRI定量及半定量评估认证资质阅片医生的评分结果为参考值,将另2位阅片医生的评分结果分别与参考值比较并计算kappa值。采用SPSS 22.0软件对数据进行统计学处理。P<0.05为结果有统计学意义。结果另2位阅片医生评分与参考值之间全部征象均kappa值≥0.6,其中软骨下骨髓水肿、软骨下囊肿、骨磨损和关节内游离体的WORMS评分在3位观察者之间具有很高的一致性(kappa值≥0.75)。与低年资阅片医生相比,高年资阅片医生与参考值之间的观察者间一致性无明显提高。结论经过标准化培训后,拥有不同临床阅片经验的放射科医生均可掌握膝关节骨关节炎WORMS评分方法,而临床阅片经验对评分效果无显著影响。Objective To evaluate the inter-observer agreements of semi-quantitative assessment of knee osteoarthritis using Whole-Organ Magnetic Resonance Imaging Score(WORMS),and furthermore,to investigate whether clinical interpretation experience affects the assessing outcomes.Methods The MR images of 10 osteoarthritic knees in the database of the clinical study"the clinical effects and mechanism of Qufengzhitong Capsule on knee osteoarthritis"were collected randomly and scored using WORMS by 3 radiologists who had various clinical interpretation experience and have been trained with WORMS scoring system.Kappa values of each feature were calculated between the observer qualified by Quantitative and Semi-quantitative MRI Evaluation Lab of Boston University(as the criteria)and the other 2 observers,respectively.Statisitical analyses were performed with SPSS 22.0 software.The level of significance was P<0.05.Results The kappa values of all features between the qualified observer and the other 2 observers were not less than 0.6.The scores of subchondral marrow edema,subchondral cyst,bone attrition and intraarticular loose body were found with high inter-observer agreements(kappa values≥0.75).Compared to the other observer,the one with more clinical interpretation experience was not detected with higher agreement with the qualified observer.Conclusion After standard training and tests,the observers with various clinical interpretation experience demonstrate proficiency in scoring knee osteoarthritis by using WORMS,and clinical interpretation experience will not affect the scoring outcomes.

关 键 词：骨关节炎 膝 磁共振成像 观察者偏差 WORMS评分 

分 类 号：R68[医药卫生—骨科学]