Hagen Petronella J, Hartmann Ieneke J C, Hoekstra Otto S, Stokkel Marcel P M, Postmus Pieter E, Prins Martin H
Department of Pulmonary Medicine, Vrije Universiteit Medical Center, Amsterdam, The Netherlands.
J Nucl Med. 2003 May;44(5):739-44.
Different criteria have been advocated for the interpretation of ventilation/perfusion (V/Q) lung scans in patients with suspected pulmonary embolism (PE). Besides these predefined criteria, many physicians use an integration of the different sets of criteria and their own experience-the so-called Gestalt interpretation. The purpose of this study was to evaluate interobserver variability and accuracy of 3 sets of criteria: the Hull and PIOPED (Prospective Investigation of Pulmonary Embolism Diagnosis) criteria and the Gestalt interpretation.
Two experienced observers interpreted V/Q scans of all 328 patients according to the 3 different schemes. The diagnostic classification obtained for the different sets of criteria was analyzed against the presence or absence of PE.
The interobserver variabilities as assessed by the kappa statistics of the PIOPED and Hull criteria and for the Gestalt interpretation were 0.70 (95% confidence interval [CI], 0.64-0.76), 0.79 (95% CI, 0.73-0.85), and 0.65 (95% CI, 0.58-0.72), respectively. The differences in kappa values between the Hull and PIOPED criteria and between the Hull criteria and Gestalt interpretation were statistically significant (P < 0.05 and P < 0.001, respectively). For 16 patients (14 without PE) with a normal lung scan result according to the Hull criteria, the result according to the PIOPED criteria was low probability. For 21 patients (12 with PE), the scans were intermediate probability according to the PIOPED criteria, whereas the result with the Hull criteria was high probability. Analysis of receiver-operating-characteristic curves yielded a comparable area under the curve for all sets of criteria (0.87-0.90).
The Hull, PIOPED, and Gestalt interpretation of V/Q lung scans all have a good accuracy and interobserver variability. However, the reproducibility of the Hull criteria is superior in comparison with that of the other sets of criteria.
对于疑似肺栓塞（PE）患者的通气/灌注（V/Q）肺扫描结果解读，一直存在不同的标准。除了这些预先设定的标准外，许多医生还会综合运用不同的标准集以及自身经验——即所谓的整体解读法。本研究的目的是评估3套标准的观察者间变异性和准确性：赫尔标准、PIOPED（肺栓塞诊断前瞻性研究）标准以及整体解读法。
两名经验丰富的观察者根据3种不同方案解读了328例患者的V/Q扫描结果。针对不同标准集获得的诊断分类，对照是否存在PE进行分析。
通过kappa统计量评估，PIOPED标准、赫尔标准以及整体解读法的观察者间变异性分别为0.70（95%置信区间[CI]，0.64 - 0.76）、0.79（95% CI，0.73 - 0.85）和0.65（95% CI，0.58 - 0.72）。赫尔标准与PIOPED标准之间以及赫尔标准与整体解读法之间的kappa值差异具有统计学意义（分别为P < 0.05和P < 0.001）。根据赫尔标准，16例肺部扫描结果正常的患者（14例无PE），按照PIOPED标准结果为低概率。对于21例患者（12例有PE），按照PIOPED标准扫描结果为中等概率，而按照赫尔标准结果为高概率。对受试者工作特征曲线的分析显示，所有标准集的曲线下面积相当（0.87 - 0.90）。
V/Q肺扫描的赫尔标准、PIOPED标准以及整体解读法均具有良好的准确性和观察者间变异性。然而，与其他标准集相比，赫尔标准的可重复性更佳。
