A New, Simple Method for Estimating Pleural Effusion Size on CT Scans
A New, Simple Method for Estimating Pleural Effusion Size on CT Scans
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DOI：
10.1378/chest.12-1292
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发表时间：
2013-04-01
期刊：
影响因子：
9.6
通讯作者：
Haramati, Linda B.
中科院分区：
文献类型：
--
作者：
Moy, Matthew P.;Levsky, Jeffrey M.;Haramati, Linda B.
背景：没有标准化的系统来对 CT 扫描上的胸腔积液大小进行分级。经过验证的系统分级系统将改善结果的交流，并可能有助于确定胸腔穿刺术影像学指导的需要。方法：使用体积分割工具测量 34 名患者的 CT 扫描，显示出各种胸腔积液的大小，并审查与大小相关的定性和简单的定量特征。使用最能预测大小并区分小、中和大量积液的特征制定了分类规则。在实施分类规则之前和之后，通过三组医生（放射科住院医师、肺科医师和心胸放射科医师）的 CT 扫描来评估读者间积液大小的一致性。结果：最能将积液分类为小、中或大的 CT 成像特征是前后位 (AP) 四分位数和在锁骨中线测量的最大 AP 深度。根据决策规则，第一 AP 四分位积液较小，第二 AP 四分位积液中等，第三或第四 AP 四分位积液较大。在临界情况下，AP 深度的测量上限分别为 3 厘米和 10 厘米，分别为小和中等。该规则的使用将所有医生的观察者间一致性从 kappa = 0.56 提高到 0.79，放射科住院医师从 0.59 提高到 0.73，肺科医生从 0.54 提高到 0.76，心胸放射科医生从 0.74 提高到 0.85。中等至显着水平。胸部 2013； 143(4):1054-1059
Background: There is no standardized system to grade pleural effusion size on CT scans. A validated, systematic grading system would improve communication of findings and may help determine the need for imaging guidance for thoracentesis.Methods: CT scans of 34 patients demonstrating a wide range of pleural effusion sizes were measured with a volume segmentation tool and reviewed for qualitative and simple quantitative features related to size. A classification rule was developed using the features that best predicted size and distinguished among small, moderate, and large effusions. Inter-reader agreement for effusion size was assessed on the CT scans for three groups of physicians (radiology residents, pulmonologists, and cardiothoracic radiologists) before and after implementation of the classification rule.Results: The CT imaging features found to best classify effusions as small, moderate, or large were anteroposterior (AP) quartile and maximum AP depth measured at the midclavicular line. According to the decision rule, first AP-quartile effusions are small, second AP-quartile effusions are moderate, and third or fourth AP-quartile effusions are large. In borderline cases, AP depth is measured with 3-cm and 10-cm thresholds for the upper limit of small and moderate, respectively. Use of the rule improved interobserver agreement from kappa = 0.56 to 0.79 for all physicians, 0.59 to 0.73 for radiology residents, 0.54 to 0.76 for pulmonologists, and 0.74 to 0.85 for cardiothoracic radiologists.Conclusions: A simple, two-step decision rule for sizing pleural effusions on CT scans improves interobserver agreement from moderate to substantial levels. CHEST 2013; 143(4):1054-1059