Interobserver agreement and diagnostic performance of individual MRI criteria for diagnosis of placental adhesion disorders
Interobserver agreement and diagnostic performance of individual MRI criteria for diagnosis of placental adhesion disorders
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DOI：
10.1016/j.crad.2018.05.021
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发表时间：
2018-10-01
影响因子：
2.6
通讯作者：
Dobrotwir, A.
中科院分区：
文献类型：
--
作者：
Goergen, S. K.;Posma, E.;Dobrotwir, A.
目的：评价几种胎盘粘连障碍(PAD)诊断标准在磁共振成像(MRI)上的诊断准确性，并根据多年的解释经验评估观察者间的一致性和阅读者的准确性。材料和方法：由3名具有10年、5年和2年胎盘MRI解释经验的放射科医生对28例胎盘粘连障碍(PAD)患者进行盲法评价。评估前置胎盘的存在、胎盘内暗带、不均一性、子宫隆起、子宫浆膜“毛茸茸的狗”样外观、胎盘外侵犯的主观印象以及弥散加权成像上的胎盘内暗带。对胎盘组织学进行盲法回顾，不考虑原始报告和MRI解释，这与分娩时的临床信息一起构成了参考标准。结果：T2加权成像上的胎盘内暗带是最敏感、最特异的，也是三位读者对PAD最一致的标准(kappa=0.7)。评估子宫膨出(kappa=0.42)和胎盘异质性(kappa=0.48)并不能提高诊断的准确性。对于经验最少的读者，DWI提高了敏感性，但降低了特异性，而对于经验更丰富的读者，DWI不改变敏感性或特异性。结论：评估胎盘暗带是MRI诊断PADS的最敏感、最特异和最具重复性的标准。(C)2018年皇家放射科医生学会。爱思唯尔有限公司出版。保留所有权利。
AIM: To assess the diagnostic accuracy of several criteria for the diagnosis of placental adhesion disorder (PAD) on magnetic resonance imaging (MRI) and to assess interobserver agreement and reader accuracy based on years of interpretive experience.MATERIALS AND METHODS: Blinded evaluation of the placental MRI studies of 28 randomly selected women, 18 with PADs and 10 without PADs, was undertaken by three radiologists with 10, 5, and 2 years' experience in placental MRI interpretation. The presence of placenta praevia, dark intraplacental bands, heterogeneity, uterine bulging, "shaggy dog" appearance of the uterine serosa, subjective impression of extraplacental invasion, and dark intraplacental bands on diffusion-weighted imaging were assessed. Placental histology was reviewed blinded to the original reports and to MRI interpretation and this, along with clinical information at the time of delivery, formed the reference standard.RESULTS: Dark intraplacental bands on T2-weighted imaging were the most sensitive and specific as well as the most agreed upon (kappa=0.7) criterion for PAD for the three readers. Assessment of uterine bulging (kappa=0.42) and placental heterogeneity (kappa=0.48) did not improve diagnostic accuracy. DWI improved sensitivity but decreased specificity for the least experienced reader and did not change sensitivity or specificity for the more experienced readers.CONCLUSION: Assessment of the placenta for dark bands is the most sensitive, specific, and reproducible criterion for diagnosis of PADs using MRI. (C) 2018 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.