Ubbink D T, Fidler M, Legemate D A
Department of Vascular Surgery, Academic Medical Center, Amsterdam, The Netherlands.
J Vasc Surg. 2001 Mar;33(3):540-5. doi: 10.1067/mva.2001.111734.
The interobserver variability of aortoiliac and femoropopliteal duplex scanning in peripheral arterial occlusive disease was assessed.
Two experienced, independent vascular technologists investigated in random order 61 consecutive patients sent to the vascular laboratory for investigation of the aortoiliac or femoropopliteal arteries. In each aortoiliac vessel segment, the proximal, mid, and distal peak systolic velocities (PSVs) were measured, and corresponding PSV ratios were calculated. The superficial femoral artery was divided in 10-cm segments with a roll-centimeter taped from the upper patella margin. Interclass correlation coefficients (ICCs) were calculated as a means of appreciating the measurement variability of the PSV ratio values as a continuous variable and the Kappa value for the PSV ratio categories of less than 2.0, 2.0 through 3.0, more than 3.0, and occlusions.
The overall ICC and Kappa values were 0.72 (95% CI, 0.63-0.79) and 0.53 for the aortoiliac tract and 0.85 (95% CI, 0.79-0.89) and 0.73 for the femoropopliteal tract. Agreement in the PSV ratio categories was 85% in the aortoiliac and 87% in the femoropopliteal tract. Interobserver variation increased markedly with increasing PSV ratio. In the PSV ratio category between 2.0 to 3.0, indicating a borderline stenosis, a substantial disagreement was found (aortoiliac, 1 of 8 agreement; femoropopliteal, 2 of 8 agreement).
A moderate interobserver agreement was found in the duplex investigation of the aortoiliac and femoropopliteal arteries. One should be aware of this in clinical decision making, especially in cases of borderline stenoses. In these cases, repetition of the measurement or additional diagnostics is advocated.
评估外周动脉闭塞性疾病中腹主动脉-髂动脉及股动脉-腘动脉双功扫描的观察者间变异性。
两名经验丰富、独立的血管技术人员对连续61例被送往血管实验室检查腹主动脉-髂动脉或股动脉-腘动脉的患者进行随机顺序检查。在每段腹主动脉-髂动脉血管节段，测量近端、中段和远端的收缩期峰值流速（PSV），并计算相应的PSV比值。股浅动脉从髌骨上缘开始用卷尺每隔10厘米进行分段。计算组内相关系数（ICC）以评估PSV比值作为连续变量的测量变异性，以及PSV比值类别（小于2.0、2.0至3.0、大于3.0和闭塞）的Kappa值。
腹主动脉-髂动脉段的总体ICC和Kappa值分别为0.72（95%CI，0.63 - 0.79）和0.53，股动脉-腘动脉段分别为0.85（95%CI，0.79 - 0.89）和0.73。腹主动脉-髂动脉段PSV比值类别一致性为85%，股动脉-腘动脉段为87%。观察者间变异随PSV比值增加而显著增大。在PSV比值为2.0至3.0的类别中，提示临界狭窄，发现存在显著分歧（腹主动脉-髂动脉段，8例中1例一致；股动脉-腘动脉段，8例中2例一致）。
在腹主动脉-髂动脉和股动脉-腘动脉的双功检查中发现观察者间一致性中等。在临床决策中应意识到这一点，尤其是在临界狭窄的情况下。在这些情况下，提倡重复测量或进行额外诊断。
