Hagen Petronella J, Hartmann Ieneke J C, Hoekstra Otto S, Stokkel Marcel P M, Teule Gerrit J J, Prins Martin H
Department of Pulmonary Medicine, Vrije Universiteit Medical Center, Amsterdam, The Netherlands.
J Nucl Med. 2002 Oct;43(10):1317-23.
The use of a so-called gestalt interpretation, an integration of different sets of criteria and the physician's own experience, has been advocated in the interpretation of lung scintigraphs of patients with clinically suspected pulmonary embolism. However, data on the reliability of this approach are limited. The aim of this study was to investigate the observer variability and accuracy of the gestalt interpretation of perfusion scintigraphy (combined with chest radiography) as well as the impact of adding ventilation scintigraphy and clinical pretest information.
Three experienced observers independently reviewed the chest radiograph and ventilation-perfusion scans of 101 consecutive patients with clinically suspected pulmonary embolism. All datasets were reviewed twice by each observer, using a visual analog scale to indicate the estimated probability of pulmonary embolism. The results of the gestalt interpretations were analyzed against the presence or absence of pulmonary embolism.
All 3 gestalt interpretations had a good-to-excellent interobserver variability (intraclass correlation coefficient [ICC], 0.73-0.89), with similar intraobserver agreement (ICC, 0.76-0.95). The performance of all 3 readers was comparable. The areas under the curve (AUCs) of all 3 observers were high and similar (for observer 1, the AUCs were 0.96 [95% confidence interval (CI)], 0.93-1.00), 0.96 (95% CI, 0.93-1.00), and 0.95 (95% CI, 0.90-1.00), respectively, for the 3 gestalt interpretations).
A gestalt interpretation is a useful classification scheme with good-to-excellent intra- and interobserver variability. However, the interpretation and the consequences of this result are dependent on the observer. Unexpectedly, the addition of information on ventilation scintigraphy and clinical information did not affect the overall assessment.
在对临床疑似肺栓塞患者的肺闪烁扫描图进行解读时,有人主张采用一种所谓的格式塔解读方法,即将不同的标准集与医生自身经验相结合。然而,关于这种方法可靠性的数据有限。本研究的目的是调查灌注闪烁扫描(结合胸部X线摄影)的格式塔解读的观察者变异性和准确性,以及添加通气闪烁扫描和临床预检信息的影响。
三位经验丰富的观察者独立审查了101例临床疑似肺栓塞患者的胸部X线片和通气-灌注扫描。每位观察者对所有数据集进行了两次审查,使用视觉模拟量表来表示肺栓塞的估计概率。根据是否存在肺栓塞对格式塔解读的结果进行分析。
所有三种格式塔解读都具有良好至优秀的观察者间变异性(组内相关系数[ICC],0.73 - 0.89),观察者内一致性相似(ICC,0.76 - 0.95)。所有三位读者的表现相当。所有三位观察者的曲线下面积(AUC)都很高且相似(对于观察者1,三种格式塔解读的AUC分别为0.96[95%置信区间(CI),0.93 - 1.00]、0.96(95%CI,0.93 - 1.00)和0.95(95%CI,0.90 - 1.00))。
格式塔解读是一种有用的分类方案,具有良好至优秀的观察者内和观察者间变异性。然而,这种解读及其结果的影响取决于观察者。出乎意料的是,添加通气闪烁扫描信息和临床信息并未影响总体评估。