Inter- and Intraobserver Agreement of 18F-FDG PET/CT Image Interpretation in Patients Referred for Assessment of Cardiac Sarcoidosis
Inter- and Intraobserver Agreement of 18F-FDG PET/CT Image Interpretation in Patients Referred for Assessment of Cardiac Sarcoidosis
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DOI：
10.2967/jnumed.116.187203
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发表时间：
2017-08-01
影响因子：
9.3
通讯作者：
Birnie, David
中科院分区：
文献类型：
--
作者：
Ohira, Hiroshi;Mc Ardle, Brian;Birnie, David
最近的研究报道了F-18-FDG PET在辅助诊断和治疗心脏结节病（CS）患者中的有用性。然而，F-18-FDG PET用于CS的图像解释有时具有挑战性。我们试图调查观察者之间和观察者内部的一致性，并探索导致阅片者之间存在重要差异的因素。方法：我们研究了连续的无明显冠状动脉疾病的患者，这些患者被转诊进行CS评估。两名经验丰富的阅片师对临床信息、成像报告设盲，独立审查F-18-FDG PET/CT图像。根据预定义的标准操作程序解读F-18-FDG PET/CT图像，心脏F-18-FDG摄取模式分为5种模式：无、局灶性、弥漫性局灶性、弥漫性和孤立侧壁或基底摄取。总体图像评估分为与活动性CS一致或不一致。结果：共纳入71例患者的100次扫描。其中，46例接受了无限制饮食的F-18-FDG PET/CT（无限制组），54例接受了低碳水化合物、高脂肪和蛋白质允许饮食的F-18-FDG PET/CT（低碳水化合物组）。100次扫描中有74次的解释类别一致。所有5个类别的一致性k值为0.64，表明一致性中等。对于总体临床解释，100次扫描中有93次一致（k = 0.85）。当扫描分为准备组时，低碳水化合物组与无限制组相比有更高的一致性趋势（80% vs. 67%，P = 0.08）。关于总体临床解释，低碳水化合物组与无限制组的一致性也更高（96% vs. 89%，P = 0.08）。结论：心脏F-18-FDG摄取图像模式的观察者间一致性中等。然而，关于CS的总体解释，一致性更好。详细的扫描前饮食准备似乎可以提高观察者之间的一致性。
Recent studies have reported the usefulness of F-18-FDG PET in aiding with the diagnosis and management of patients with cardiac sarcoidosis (CS). However, image interpretation of F-18-FDG PET for CS is sometimes challenging. We sought to investigate the interand intraobserver agreement and explore factors that led to important discrepancies between readers. Methods: We studied consecutive patients with no significant coronary artery disease who were referred for assessment of CS. Two experienced readers masked to clinical information, imaging reports, independently reviewed F-18-FDG PET/CT images. F-18-FDG PET/CT images were interpreted according to a predefined standard operating procedure, with cardiac F-18-FDG uptake patterns categorized into 5 patterns: none, focal, focal on diffuse, diffuse, and isolated lateral wall or basal uptake. Overall image assessment was classified as either consistent with active CS or not. Results: One hundred scans were included from 71 patients. Of these, 46 underwent F-18-FDG PET/CT with a no-restriction diet (no-restriction group), and 54 underwent F-18-FDG PET/CT with a low-carbohydrate, high-fat and proteinpermitted diet (low-carb group). There was agreement of the interpretation category in 74 of 100 scans. The k-value of agreement among all 5 categories was 0.64, indicating moderate agreement. For overall clinical interpretation, there was agreement in 93 of 100 scans (k = 0.85). When scans were divided into the preparation groups, there was a trend toward higher agreement in the low-carb group versus the no-restriction group (80% vs. 67%, P = 0.08). Regarding the overall clinical interpretation, there was also a trend toward greater agreement in the low-carb group versus the no-restriction group (96% vs. 89%, P = 0.08). Conclusion: The interobserver agreement of cardiac F-18-FDG uptake image patterns was moderate. However, agreement was better regarding overall interpretation of CS. Detailed prescan dietary preparation seemed to improve interobserver agreement.