基于MRI的肾囊性病变2005版BosniakⅡ~Ⅲ类阅片者间一致性分析

孙松梅; 白旭; 李林; 张晶; 张晓晶; 许伟; 于梅艳; 王美凤; 叶慧义; 王海屹

doi:10.3969/j.issn.2095-5227.2021.05.008

基于MRI的肾囊性病变2005版BosniakⅡ~Ⅲ类阅片者间一致性分析

Interobserver agreement on cystic renal masses of Bosniak (2005) categories Ⅱ to Ⅲ based on MRI

摘要

摘要:
背景肾囊性病变的Bosniak分类影响临床决策，现有阅片者间一致性研究多采用计算机体层成像(computed tomography，CT)图像，而磁共振成像(magnetic resonance imaging，MRI)正凭借其优越的图像分辨率和软组织对比度、提供更详细的影像学信息，临床应用日益广泛。
目的本研究通过评估不同阅片者基于MRI、依据现行的2005版Bosniak分类系统判读Ⅱ～Ⅲ类肾囊性病变(cystic renal mass，CRM)的一致性，为临床决策提供影像学依据。
方法收集解放军总医院第一医学中心2009年1月- 2018年12月完成常规MRI平扫及增强检查并符合2005版Bosniak Ⅱ～Ⅲ分类标准的CRM病例，由3名影像医师依据2005版Bosniak分类系统对MRI图像进行独立判读并记录分类结果，通过计算全部病例、不同分类和不同病理类型病例的阅片者间一致性加权Kappa系数(Cohen/Conger’s Kappa，k_w)，衡量全部病例、不同分类和不同病理类型病例的阅片者间一致性。
结果共有123例患者的123个CRM纳入本研究，其中男84例，女39例，平均年龄(49.1±11.1)岁，单纯囊肿、良性肿瘤和恶性肿瘤分别有61例(49.6%)、15例(12.2%)、47例(38.2%)，Ⅱ、ⅡF、Ⅲ类病例分别有24例(19.5%)、49例(39.8%)、50例(40.7%)。全部病例阅片者间一致性k_w系数为0.43。Ⅱ、ⅡF、Ⅲ类病例的k_w系数分别为0.05、0.34、0.29；单纯囊肿、良性肿瘤、恶性肿瘤的k_w系数分别为0.33、0.16、0.31。
结论基于2005版Bosniak分类系统，对于全部病例阅片者间一致性程度中等；Bosniak Ⅱ类病例的一致性较低；Bosniak ⅡF和Ⅲ类病例的一致性一般；单纯囊肿和恶性肿瘤的一致性均一般；良性肿瘤的一致性较低；单纯囊肿的一致性高于良性肿瘤和恶性肿瘤。

Abstract:
Background The Bosniak classification of cystic renal masses (CRM) affects clinical decision-making. Most existing studies on the interobserver agreement use computed tomography (CT) images. However, magnetic resonance imaging (MRI), with its superior image resolution, soft tissue contrast, and being able to provide more detailed imaging information, is increasingly used in clinical practice.
Objective To assess the interobserver agreement on MRI images of categories Ⅱ - Ⅲ cystic renal masses (CRM) according to Bosniak classification system (2005).
Methods All CRM cases who accepted routine MRI scans or enhanced examinations in the First Medical Center of Chinese PLA General Hospital from January 2009 to December 2018, and met Bosniak Ⅱ, ⅡF and Ⅲ criteria were collected. Three radiologists independently rated the MRI images and recorded the ratings according to the Bosniak classification system. The weighted Cohen/Conger's Kappa (kw) was calculated for all cases, Bosniak categories and pathological types were served as the measurement of interobserver agreement.
Results A total of 123 CRMs from 123 patients were included. There were 84 males and 39 females, with an average age of 49.0 ± 11.1 years old. Among them, 61 (49.6%) cases had simple cyst, 15 (12.2%) cases had benign tumor and 47 (38.2%) cases with malignant tumor; 24 (19.5%) cases had Bosniak Ⅱ, 49 (39.8%) cases had Bosniak ⅡF and 50 (40.7%) cases had Bosniak Ⅲ. For all cases, the Kw was 0.43. The Kw for Ⅱ, ⅡF and Ⅲ cases was 0.05, 0.34 and 0.29, respectively, and that for simple cysts, benign tumors, and malignant tumors was 0.33, 0.16 and 0.31, respectively.
Conclusion The interobserver agreement of all Bosniak Ⅱ - Ⅲ CRMs based on MRI is moderate. The agreement for Bosniak Ⅱ is weak, that for Bosniak ⅡF and Bosniak Ⅲ are both fair. The agreement is fair for simple cysts and malignant tumors, but weak for benign tumors. The agreement for simple cysts is higher than that for the other two types of tumors.

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