Abstract
Purpose
This study was done to determine the diagnostic value of whole-body magnetic resonance using diffusion-weighted imaging with background suppression (WB-DWIBS) for detecting bone metastases compared with whole-body bone scintigraphy (WB-BS).
Materials and methods
Twenty-three patients with solid tumours underwent both WB-DWIBS imaging and WBBS. A nuclear medicine specialist interpreted WB-BS images and two blinded radiologists, first independently and then jointly, interpreted the WB-DWIBS images by completing a reading grid categorising the skeletal segments. Cohen’s k statistic was used to determine interobserver agreement in reading the WB-DWIBS images and the agreement between WB-BS and WB-DWIBS. Sensitivity and specificity were calculated per patient and per lesion.
Results
Interobserver agreement in reading the WBDWIBS images was substantial or good, with κ=0.68. Analysis of agreement between the nuclear physician’s and the radiologists’ readings provided κ=0.87 [95% confidence interval (CI)=0.76–0.98)] Per-lesion analysis gave a sensitivity of 80% (95% CI=75–85) and a specificity of 98.2% (95% CI=96.5–99.8).
Conclusions
We found a good level of interobserver agreement for the WB-DWIBS images and an excellent level of agreement in the subjective judgement of presence or absence of disease between WB-BS and WB-DWIBS after consensual double reading. WB-DWIBS has the same specificity as WB-BS in detecting bone metastases. The anatomical sites exhibiting the highest level of disagreement between WB-DWIBS and WB-BS are the pelvis, the coccyx, and the sternum, all sites at which detection with WB-BS has the greatest limitations.
Riassunto
Obiettivo
Scopo del presente lavoro è stato confrontare il valore diagnostico della risonanza magnetica (RM) whole body con tecnica diffusion weighted imaging with background body signal suppression (WB-DWIBS), nella identificazione delle metastasi ossee rispetto alla scintigrafia ossea total-body (SOTB), metodica di riferimento.
Materiali e metodi
Ventitré pazienti affetti da patologia tumorale solida sono stati sottoposti sia a esame WBDWIBS che SOTB. Un medico nucleare ha interpretato le immagini della SOTB e due medici radiologi prima individualmente rispettivamente in cieco e poi esprimendo un parere congiunto hanno letto e interpretato le immagini di WB-DWIBS, compilando una scheda di lettura predefinita con una categorizzazione dei segmenti scheletrici. è stata calcolata la concordanza interosservatore per la lettura delle immagini WB-DWIBS e anche la concordanza tra le due tecniche (WB-DWIBS e SOTB) con il test k di Cohen. è stata calcolata la sensibilità e la specificità della metodica sia per paziente, che per lesione.
Risultati
La concordanza inter-osservatore nella lettura delle immagini WB-DWIBS è risultata sostanziale o buona con k=0,68. L’analisi dell’accordo tra la lettura del medico nucleare e del radiologo, calcolata mediante il k statistico di Cohen, ha fornito un valore di k=0,87 [95% intervallo di confidenza (CI)=0,76–0,98]. Nell’analisi per lesione il calcolo della sensibilità ha fornito un valore dell’80% (95% CI=75%–85%) e un valore di specificità pari al 98,2% (95% CI=96,5%-99,8%).
Conclusioni
Dall’analisi dei risultati si osservano una buona corrispondenza delle letture radiologiche della WB-DWIBS e un ottimo accordo nel giudizio soggettivo di presenza o assenza di lesioni tra la SOTB e la WB-DWIBS effettuata in doppia lettura in consensus. La WB-DWIBS mostra una specificità pari a quella della SOTB nella identificazione delle localizzazioni ossee di malattia. Le sedi anatomiche di maggiore discordanza tra DWIBS e SOTB sono rappresentate dal bacino, coccige e sterno, sedi nelle quali la SOTB trova i suoi principali limiti di detezione
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Stecco, A., Lombardi, M., Leva, L. et al. Diagnostic accuracy and agreement between whole-body diffusion MRI and bone scintigraphy in detecting bone metastases. Radiol med 118, 465–475 (2013). https://doi.org/10.1007/s11547-012-0870-2
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DOI: https://doi.org/10.1007/s11547-012-0870-2