McBride Kevin J., O'Donnell Thomas F., Pauker Stephen G., Millan Victor A., Callow Allan D.
Vascular Laboratory and Departments of Surgery and Medicine, Tufts University School of Medicine at New England Medical Center Hospital, Boston, Massachusetts.
Cardiovasc Dis. 1981 Dec;8(4):499-508.
The pitfall of several reviews of noninvasive venous assessment has been the expression of the test data solely in terms of diagnostic accuracy (the number of correct tests in ratio to all tests performed), where results of a test will vary according to disease prevalence. The advantages of receiver operator characteristic curve analysis are twofold: (1) it describes the dynamic relationship between sensitivity (the ratio of the number of true positive tests to the patients with deep venous thrombosis) and specificity (the ratio of true negative tests to the number of patients with no deep venous thrombosis) independent of disease prevalence; and (2) the threshold criteria that defines a positive test can be set by the best balance between sensitivity and specificity and then applied to a given patient population for its diagnostic accuracy. Venous volume plethysmography is a widely used, simple and rapid method. It was compared to the "gold standard" of phlebography in a prospective blind study of 70 limbs that were clinically suspect of having deep venous thrombosis (DVT). Venous volume displacement plethysmography was defined objectively by three quantitative parameters: (1) maximum venous outflow, (2) integer ratio, and (3) segmental venous capacitance ratio. The DVT (22 to 70 positive phlebograms) was divided by anatomic location into either calf vein DVT or proximal DVT (popliteal vein or above). By combining these three parameters, a balance between sensitivity and specificity was obtained to provide a rapid, objective method for screening patients with suspected DVT.
多项无创静脉评估综述的缺陷在于，仅根据诊断准确性（正确检测次数与所有进行检测次数的比率）来表述检测数据，而检测结果会因疾病患病率而异。受试者工作特征曲线分析有两个优点：（1）它描述了灵敏度（真阳性检测次数与深静脉血栓形成患者数量的比率）和特异性（真阴性检测次数与无深静脉血栓形成患者数量的比率）之间的动态关系，且不受疾病患病率影响；（2）定义阳性检测的阈值标准可通过灵敏度和特异性之间的最佳平衡来设定，然后应用于特定患者群体以评估其诊断准确性。静脉容积描记法是一种广泛使用、简单且快速的方法。在一项对70条临床怀疑患有深静脉血栓形成（DVT）的肢体进行的前瞻性盲法研究中，将其与静脉造影的“金标准”进行了比较。静脉容积位移描记法通过三个定量参数进行客观定义：（1）最大静脉流出量，（2）整数比，以及（3）节段性静脉容量比。DVT（22至70例阳性静脉造影）按解剖位置分为小腿静脉DVT或近端DVT（腘静脉或以上）。通过结合这三个参数，在灵敏度和特异性之间取得了平衡，从而提供了一种快速、客观的方法来筛查疑似DVT患者。
