Background: Delay in diagnosing metastatic epidural spinal cord compression (MESCC) adversely impacts clinical outcomes. High-grade MESCC is frequently overlooked on routine staging CT scans. We aim to assess the potential of our deep learning model (DLM) in detecting high-grade MESCC and reducing diagnostic delays. Methods: This retrospective review analyzed 140 patients with surgically treated MESCC between C7 and L2 during 2015–2022. An experienced radiologist (serving as the reference standard), a consultant spine surgeon, and the DLM independently classified staging CT scans into high-grade MESCC or not. The findings were compared to original radiologist (OR) reports; inter-rater agreement was assessed. Diagnostic delay referred to the number of days elapsed from CT to diagnostic MRI scan. Results: Overall, 95/140 (67.8%) patients had preoperative CT scans. High-grade MESCC was identified in 84/95 (88.4%) of the scans by the radiologist (reference standard), but in only 32/95 (33.7%) of the preoperative scans reported by the OR. There was almost perfect agreement between the radiologist and the surgeon (kappa = 0.947, 95% CI = 0.893–1.000) (p< 0.001), and between the radiologist and the DLM (kappa = 0.891, 95% CI = 0.816–0.967) (p< 0.001). In contrast, inter-observer agreement between the OR and all other readers was slight (kappa range = 0.022–0.125). Diagnostic delay was potentially reduced by 20 ± 28 (range = 1–131) days. Conclusions: The original radiologist reports frequently missed high-grade MESCC in staging CT. Our DLM for CT diagnosis of high-grade MESCC showed almost perfect inter-rater agreement with two experienced reviewers. This study is the first to demonstrate that the DLM could help reduce diagnostic delays. Further prospective research is required to understand its precise role in improving the early diagnosis/treatment of MESCC.
背景：转移性硬膜外脊髓压迫（MESCC）的诊断延迟会对临床结局产生不利影响。常规分期CT扫描常会漏诊重度MESCC。本研究旨在评估深度学习模型（DLM）在检测重度MESCC和减少诊断延迟方面的潜力。方法：本回顾性研究分析了2015年至2022年间140例接受手术治疗的C7至L2节段MESCC患者。由经验丰富的放射科医师（作为参考标准）、脊柱外科顾问医师及DLM分别对分期CT扫描进行重度MESCC分类判定。将结果与原始放射科医师（OR）报告进行对比，并评估观察者间一致性。诊断延迟定义为从CT检查到诊断性MRI扫描间隔的天数。结果：总体而言，95/140例（67.8%）患者有术前CT扫描。放射科医师（参考标准）在84/95例（88.4%）扫描中识别出重度MESCC，而OR报告的术前扫描中仅32/95例（33.7%）被识别。放射科医师与外科医师间（kappa = 0.947，95% CI = 0.893–1.000）（p<0.001），以及放射科医师与DLM间（kappa = 0.891，95% CI = 0.816–0.967）（p<0.001）均呈现几乎完全一致。相比之下，OR与其他所有阅片者间的观察者一致性仅为轻微水平（kappa值范围=0.022–0.125）。诊断延迟可能减少20±28天（范围=1–131天）。结论：原始放射科医师报告在分期CT中常漏诊重度MESCC。我们用于重度MESCC CT诊断的DLM与两位经验丰富的评估者表现出几乎完全一致的观察者间一致性。本研究首次证明DLM有助于减少诊断延迟。需要进一步的前瞻性研究以明确其在改善MESCC早期诊断/治疗中的确切作用。
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