门静脉血栓CT评估的读者间一致性研究
这项回顾性双中心研究纳入44例门静脉血栓患者，评估基于CT的门静脉血栓测量读者间信度，以支持VALDIG标准化疗效标准制定。两位腹部放射科医师独立评估血栓特征，结果显示基于直径的定量评估读者间重复性高于基于面积的测量，基于直径的三级分类达到较高一致性，与当前肝病指南一致。
要点
- 基于直径的残余管腔评估读者间一致性最高（ICC=0.93），优于基于面积的测量（ICC=0.83）。
- 血栓厚度和长度的ICC分别为0.92和0.84，直径指标的一致性界限更窄（±22%）。
- 基于直径的三级和四级闭塞分类加权κ分别为0.71和0.78，三级分类与肝病指南一致。
关键影像表现/征象
- 门静脉主干血栓定量连续测量包括血栓长度、厚度以及基于直径（%RLdiam）和表面积（%RLsurf）的残余管腔评估。
- 分类评估采用三级和四级闭塞量表，定性分类评估累及右门静脉分支、左门静脉分支、脾静脉和肠系膜上静脉。
诊断标准与关键数值
- 血栓厚度ICC=0.92，长度ICC=0.84。
- 基于直径的残余管腔评估ICC=0.93，优于基于表面积的ICC=0.83。
- Bland-Altman图显示基于直径指标的界限为±22%，基于表面积指标的界限为-32%至+40%。
- 基于直径的分类一致性：三级系统加权κ=0.71，四级系统加权κ=0.78。
- 半定量评估一致性：右门静脉分支κ=0.77，肠系膜上静脉κ=0.72。
临床应用与阅片要点
- 日常阅片和报告中对门静脉血栓建议优先采用基于直径的定量评估（如残余管腔直径百分比），其读者间重复性更高。
- 基于直径的三级闭塞分类与当前肝病指南一致，可用于临床实践和研究中的标准化报告。
局限性
- 回顾性研究设计。
- 样本量44例，相对有限。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
BACKGROUND AND AIMS: To evaluate the inter-reader reliability of CT-based measurements of portal vein thrombosis (PVT) to support the development of standardized response criteria endorsed by the Vascular Liver Disease Group (VALDIG) group.
METHODS: In this retrospective bi-centric study, 44 patients with PVT who underwent contrast-enhanced CT (2020-2024) were included. Two independent abdominal radiologists evaluated thrombus characteristics using pre-specified standardized measurements on portal venous phase CT acquisition. For the analysis of the main PVT, quantitative continuous measurement included thrombus length, thickness, and remnant lumen assessment based on diameter (%RLdiam) and surface area (%RLsurf). Categorical classifications were derived using both three-tier and four-tier occlusion scales. Qualitative categorical assessments were performed for involvement of the right and left portal branches, splenic vein, and superior mesenteric vein. Inter-reader agreement was assessed using intraclass correlation coefficients (ICC), weighted and unweighted Cohen's kappa (κ), and Bland Altman plots.
RESULTS: Inter-reader agreement for thrombus thickness and length yielded ICC values of 0.92 and 0.84 respectively. Agreement was highest for diameter-based remnant lumen assessment (%RLdiam; ICC = 0.93), outperforming surface-based measurements (%RLsurf; ICC = 0.83). Bland Altman plots confirmed narrower limits of agreement for diameter-based metrics (±22%) compared with surface-based metrics (-32% to +40%). Categorical classification based on diameter showed substantial agreement (weighted κ = 0.71 and 0.78 for three- and four-tier systems, respectively). Semi-quantitative assessment demonstrated substantial concordance, particularly for the right portal branch (κ = 0.77) and superior mesenteric vein (κ = 0.72).
CONCLUSIONS: Diameter-based quantitative assessment of PVT on CT demonstrates higher inter-reader reproducibility than surface-based measurements. The three-tier diameter-based categorization achieved substantial agreement and aligns with current hepatology guidelines, supporting its applicability in clinical practice and research settings.
引用
- Plaforet V, Moga L, Elkrief L, et al. Inter-reader agreement for the assessment of portal vein thrombosis on computed tomography. Abdom Radiol (NY). 2026. PMID: 42012491. doi:10.1007/s00261-026-05510-4
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。