Verweij Johannes W, Hofstee Herman M A, Golding Richard P, van Waesberghe Jan-Hein T M, Smulders Yvo M
Department of Internal Medicine, VU University Medical Centre, De Boelelaan, Amsterdam.
J Comput Assist Tomogr. 2009 Nov-Dec;33(6):952-5. doi: 10.1097/RCT.0b013e3181a2f7fa.
The objective of this study was to assess the interobserver agreement between on-call radiology residents and radiology specialists in the evaluation of pulmonary embolism (PE) using computed tomographic pulmonary angiography (CTPA).
Single center, prospective cohort study of 119 consecutive inpatients and outpatients with clinically suspected PE in whom CTPA was performed during out-of-office hours and weekends. The on-call radiology resident interpreted the CTPA for the presence of PE. An experienced radiology specialist, without knowledge of earlier reading, reviewed the CTPA the following morning. In discordant cases, a consensus reading was conducted. The radiology specialists' assessment and the consensus reading in case of discordance were considered as the gold standard.
Five CTPA studies were excluded from the analysis. In the remaining cases, radiology residents and radiology specialists agreed on the interpretations of CTPAs (no PE vs PE present) in 106 (93%) of the 114 cases, with a kappa value of 0.84 (95% confidence interval, 0.74-0.95). The consensus reading equally disagreed with both radiology resident and radiology specialist in 8 (7%) of the 114 discordant cases. Seven out of 8 discordant cases had suboptimal scan quality.
The assessment of CTPA in patients with suspected PE by radiology residents seems reliable during out-of-office hours.
本研究的目的是评估值班放射科住院医师与放射科专家在使用计算机断层扫描肺动脉造影（CTPA）评估肺栓塞（PE）时的观察者间一致性。
对119例连续的临床疑似PE的住院患者和门诊患者进行单中心前瞻性队列研究，这些患者在非工作时间和周末进行了CTPA检查。值班放射科住院医师解读CTPA以判断是否存在PE。一位经验丰富的放射科专家在不知情的情况下于次日上午复查CTPA。在意见不一致的情况下，进行共识解读。放射科专家的评估以及意见不一致时的共识解读被视为金标准。
五项CTPA研究被排除在分析之外。在其余病例中，放射科住院医师和放射科专家在114例病例中的106例（93%）对CTPA的解读（无PE与存在PE）达成一致，kappa值为0.84（95%置信区间，0.74 - 0.95）。在114例意见不一致的病例中，有8例（7%）的共识解读与放射科住院医师和放射科专家的意见均不一致。8例意见不一致的病例中有7例扫描质量欠佳。
放射科住院医师在非工作时间对疑似PE患者的CTPA评估似乎是可靠的。
