{"title":"t1 -高强度囊性肾肿块：MR减影成像可以提高观察者之间的一致性和Bosniak分类的诊断性能。","authors":"Huanhuan Kang, Huiping Guo, Xueyi Ning, Wei Xu, Haili Liu, Zhe Liu, Xiaohui Ding, Xu Bai, Chaobo Li, Xuewei Wen, Sicheng Yi, Mengqiu Cui, Jian Zhao, Lin Li, Xiaojing Zhang, Qingbo Huang, Huiyi Ye, Xin Ma, Haiyi Wang","doi":"10.1002/jmri.29822","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>T1-hyperintensity in cystic renal masses (CRMs) complicates Bosniak classification assessment due to inherent signal interference from hemorrhage and proteinaceous content, potentially obscuring enhancement visibility.</p><p><strong>Purpose: </strong>To investigate whether MR subtraction imaging improves interobserver agreement and diagnostic performance in the Bosniak classification of T1-hyperintense CRMs.</p><p><strong>Study type: </strong>Retrospective.</p><p><strong>Population: </strong>A total of 139 consecutive patients (mean age, 50 ± 12 years; 97 males) with 141 T1-hyperintense CRMs were included, consisting of surgically confirmed 133 lesions and clinically diagnosed 8 benign CRMs that were stable during follow-up (≥ 5 years).</p><p><strong>Field strength/sequence: </strong>1.5/3 T. fat-saturated T2-weighted imaging, diffusion-weighted imaging, unenhanced, and triphasic dynamic contrast-enhanced T1-weighted imaging (T1WI). Subtraction images were generated automatically by subtracting unenhanced from triphasic contrast-enhanced T1WI.</p><p><strong>Assessment: </strong>Six radiologists (half less experienced) independently classified all T1-hyperintense CRMs using the Bosniak classification (v2019) in two sessions, with and without subtraction imaging. A 1-month washout period was implemented between sessions, and the order of cases was re-randomized. Interobserver agreement and diagnostic performance were evaluated in all experienced and less experienced readers.</p><p><strong>Statistical tests: </strong>Weighted κ statistics assessed interobserver agreement. Diagnostic performance (the area under the curve [AUC], sensitivity, specificity) was compared using Delong and McNemar tests. Statistical significance was defined as p < 0.05.</p><p><strong>Results: </strong>Subtraction imaging significantly improved interobserver agreement in all radiologists (weighted κ = 0.62 vs. 0.46), and less experienced radiologists (3-5 years of experience, weighted κ = 0.63 vs. 0.42), though not significantly among experienced radiologists (10-15 years of experience, weighted κ = 0.61 vs. 0.52; p = 0.051). Less experienced radiologists showed significantly higher AUC (0.865 vs. 0.804), sensitivity (88.9% vs. 75.5%), and specificity (88.2% vs. 72.5%) with MR subtraction imaging.</p><p><strong>Data conclusion: </strong>MR subtraction imaging may improve overall interobserver agreement in the Bosniak classification of T1-hyperintense CRMs. Furthermore, it could improve diagnostic accuracy and interobserver agreement among less experienced radiologists.</p><p><strong>Evidence level: </strong>4.</p><p><strong>Technical efficacy: </strong>Stage 2.</p>","PeriodicalId":16140,"journal":{"name":"Journal of Magnetic Resonance Imaging","volume":" ","pages":""},"PeriodicalIF":3.3000,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"T1-Hyperintense Cystic Renal Masses: MR Subtraction Imaging May Improve Interobserver Agreement and Diagnostic Performance in the Bosniak Classification.\",\"authors\":\"Huanhuan Kang, Huiping Guo, Xueyi Ning, Wei Xu, Haili Liu, Zhe Liu, Xiaohui Ding, Xu Bai, Chaobo Li, Xuewei Wen, Sicheng Yi, Mengqiu Cui, Jian Zhao, Lin Li, Xiaojing Zhang, Qingbo Huang, Huiyi Ye, Xin Ma, Haiyi Wang\",\"doi\":\"10.1002/jmri.29822\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>T1-hyperintensity in cystic renal masses (CRMs) complicates Bosniak classification assessment due to inherent signal interference from hemorrhage and proteinaceous content, potentially obscuring enhancement visibility.</p><p><strong>Purpose: </strong>To investigate whether MR subtraction imaging improves interobserver agreement and diagnostic performance in the Bosniak classification of T1-hyperintense CRMs.</p><p><strong>Study type: </strong>Retrospective.</p><p><strong>Population: </strong>A total of 139 consecutive patients (mean age, 50 ± 12 years; 97 males) with 141 T1-hyperintense CRMs were included, consisting of surgically confirmed 133 lesions and clinically diagnosed 8 benign CRMs that were stable during follow-up (≥ 5 years).</p><p><strong>Field strength/sequence: </strong>1.5/3 T. fat-saturated T2-weighted imaging, diffusion-weighted imaging, unenhanced, and triphasic dynamic contrast-enhanced T1-weighted imaging (T1WI). Subtraction images were generated automatically by subtracting unenhanced from triphasic contrast-enhanced T1WI.</p><p><strong>Assessment: </strong>Six radiologists (half less experienced) independently classified all T1-hyperintense CRMs using the Bosniak classification (v2019) in two sessions, with and without subtraction imaging. A 1-month washout period was implemented between sessions, and the order of cases was re-randomized. Interobserver agreement and diagnostic performance were evaluated in all experienced and less experienced readers.</p><p><strong>Statistical tests: </strong>Weighted κ statistics assessed interobserver agreement. Diagnostic performance (the area under the curve [AUC], sensitivity, specificity) was compared using Delong and McNemar tests. Statistical significance was defined as p < 0.05.</p><p><strong>Results: </strong>Subtraction imaging significantly improved interobserver agreement in all radiologists (weighted κ = 0.62 vs. 0.46), and less experienced radiologists (3-5 years of experience, weighted κ = 0.63 vs. 0.42), though not significantly among experienced radiologists (10-15 years of experience, weighted κ = 0.61 vs. 0.52; p = 0.051). 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引用次数: 0
摘要
背景：由于出血和蛋白质含量的固有信号干扰，囊性肾肿块（CRMs）的t1 -高信号使Bosniak分级评估复杂化，潜在地模糊了增强可视性。目的：探讨MR减影成像是否能提高观察者间的一致性和诊断t1 -高强度CRMs的Bosniak分类。研究类型：回顾性。人群：共139例连续患者(平均年龄50±12岁；纳入97例（男性），141例t1 -高恶性肿瘤，其中手术确诊病变133例，临床诊断良性肿瘤8例，随访稳定（≥5年）。场强/序列：1.5/3 T。脂肪饱和t2加权成像、扩散加权成像、未增强和三相动态对比增强t1加权成像（T1WI）。通过对三相增强的T1WI进行未增强的减影，自动生成减影图像。评估：六名放射科医生（一半经验不足）在两次会议中使用Bosniak分类（v2019）独立对所有t1 -高强度CRMs进行了分类，有和没有减法成像。两次治疗之间有1个月的洗脱期，病例的顺序重新随机化。在所有有经验和经验不足的读者中评估观察者间的一致性和诊断表现。统计检验：加权κ统计评估观察者间的一致性。采用Delong和McNemar试验比较诊断性能（曲线下面积[AUC]、敏感性和特异性）。结果：减法成像显著改善了所有放射科医生（加权κ = 0.62 vs. 0.46）和经验不足的放射科医生（3-5年经验，加权κ = 0.63 vs. 0.42）的观察者间一致性，但在经验丰富的放射科医生(10-15年经验，加权κ = 0.61 vs. 0.52；p = 0.051)。经验不足的放射科医生在MR减影成像中显示出更高的AUC（0.865比0.804）、灵敏度（88.9%比75.5%）和特异性（88.2%比72.5%）。数据结论：MR减影成像可以提高t1 -高强度CRMs的Bosniak分类的整体观察者间一致性。此外，它可以提高诊断的准确性和经验不足的放射科医生之间的观察者之间的一致性。证据等级：4。技术功效：第二阶段。
T1-Hyperintense Cystic Renal Masses: MR Subtraction Imaging May Improve Interobserver Agreement and Diagnostic Performance in the Bosniak Classification.
Background: T1-hyperintensity in cystic renal masses (CRMs) complicates Bosniak classification assessment due to inherent signal interference from hemorrhage and proteinaceous content, potentially obscuring enhancement visibility.
Purpose: To investigate whether MR subtraction imaging improves interobserver agreement and diagnostic performance in the Bosniak classification of T1-hyperintense CRMs.
Study type: Retrospective.
Population: A total of 139 consecutive patients (mean age, 50 ± 12 years; 97 males) with 141 T1-hyperintense CRMs were included, consisting of surgically confirmed 133 lesions and clinically diagnosed 8 benign CRMs that were stable during follow-up (≥ 5 years).
Field strength/sequence: 1.5/3 T. fat-saturated T2-weighted imaging, diffusion-weighted imaging, unenhanced, and triphasic dynamic contrast-enhanced T1-weighted imaging (T1WI). Subtraction images were generated automatically by subtracting unenhanced from triphasic contrast-enhanced T1WI.
Assessment: Six radiologists (half less experienced) independently classified all T1-hyperintense CRMs using the Bosniak classification (v2019) in two sessions, with and without subtraction imaging. A 1-month washout period was implemented between sessions, and the order of cases was re-randomized. Interobserver agreement and diagnostic performance were evaluated in all experienced and less experienced readers.
Statistical tests: Weighted κ statistics assessed interobserver agreement. Diagnostic performance (the area under the curve [AUC], sensitivity, specificity) was compared using Delong and McNemar tests. Statistical significance was defined as p < 0.05.
Results: Subtraction imaging significantly improved interobserver agreement in all radiologists (weighted κ = 0.62 vs. 0.46), and less experienced radiologists (3-5 years of experience, weighted κ = 0.63 vs. 0.42), though not significantly among experienced radiologists (10-15 years of experience, weighted κ = 0.61 vs. 0.52; p = 0.051). Less experienced radiologists showed significantly higher AUC (0.865 vs. 0.804), sensitivity (88.9% vs. 75.5%), and specificity (88.2% vs. 72.5%) with MR subtraction imaging.
Data conclusion: MR subtraction imaging may improve overall interobserver agreement in the Bosniak classification of T1-hyperintense CRMs. Furthermore, it could improve diagnostic accuracy and interobserver agreement among less experienced radiologists.
期刊介绍：
The Journal of Magnetic Resonance Imaging (JMRI) is an international journal devoted to the timely publication of basic and clinical research, educational and review articles, and other information related to the diagnostic applications of magnetic resonance.
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