将 CT 上的低密影归因于血管造影痉挛并不敏感且不可靠。
Attributing hypodensities on CT to angiographic vasospasm is not sensitive and unreliable.
机构信息
Division of Neurosurgery, St Michael's Hospital, Toronto, ON M5B 1W8, Canada.
出版信息
Stroke. 2012 Jan;43(1):109-12. doi: 10.1161/STROKEAHA.111.632745. Epub 2011 Oct 13.
BACKGROUND AND PURPOSE
The presence of low-density areas on CT is used in clinical decision-making regarding treatment of angiographic vasospasm as well as in research as a surrogate marker for severity of angiographic vasospasm. We assess the interobserver variability in attributing hypodensities on CT to angiographic vasospasm-related delayed ischemic neurological deficit.
METHODS
Three experienced reviewers, 2 neurosurgeons, and a neuroradiologist independently reviewed CT scans of 413 patients enrolled in the Clazosentan to Overcome Neurological iSChemia and Infarction OccUrring after Subarachnoid hemorrhage (CONSCIOUS-1) trial, who universally underwent catheter angiography to determine severity of angiographic vasospasm. Interobserver variability was calculated using the κ statistic and the χ(2) test was used to determine associations between dichotomized outcomes.
RESULTS
There was considerable interobserver variability in attributing CT hypodensities to vasospasm-related delayed ischemic neurological deficit (κ=0.51-0.78; 95% CI, 0.35-0.90). Patients with hypodensities attributed to delayed ischemic neurological deficit were significantly more likely to have severe angiographic vasospasm (P=0.001), but a substantial proportion of these patients (19%) also had mild or no spasm. CT hypodensities had a sensitivity and specificity of 41% and 93%, respectively, in identifying patients with severe angiographic vasospasm, even with expert consensus that these represent angiographic vasospasm-related delayed ischemic neurological deficit.
CONCLUSIONS
We find considerable interobserver variability in attributing CT hypodensities to angiographic vasospasm and propose that they may not be a robust marker of severity of angiographic vasospasm, even with unanimous expert agreement that they are a result of vasospasm-related delayed ischemic neurological deficit.
CLINICAL TRIAL REGISTRATION
URL: www.clinicaltrials.gov. Unique identifier: NCT00111085.
背景与目的
CT 上低密度区域的存在被用于临床决策，以决定是否对血管痉挛进行治疗，也被用于研究，作为血管痉挛严重程度的替代标志物。我们评估了将 CT 上的低密度归因于血管痉挛相关性迟发性缺血性神经功能缺损的观察者间变异性。
方法
3 名经验丰富的审查员（2 名神经外科医生和 1 名神经放射科医生）独立审查了 Clazosentan 治疗蛛网膜下腔出血后神经缺血和梗死（CONSCIOUS-1）试验中 413 名患者的 CT 扫描，所有患者均普遍接受了导管血管造影术以确定血管痉挛的严重程度。观察者间变异性使用κ统计量进行计算，二项分类结果之间的相关性使用χ²检验进行评估。
结果
将 CT 低密度归因于血管痉挛相关性迟发性缺血性神经功能缺损的观察者间变异性很大（κ=0.51-0.78；95%CI，0.35-0.90）。归因于迟发性缺血性神经功能缺损的 CT 低密度患者发生严重血管痉挛的可能性显著更高（P=0.001），但这些患者中有相当大的一部分（19%）也存在轻度或无痉挛。即使专家一致认为这些代表血管痉挛相关性迟发性缺血性神经功能缺损，CT 低密度在识别严重血管痉挛患者方面的敏感性和特异性分别为 41%和 93%。
结论
我们发现将 CT 低密度归因于血管痉挛的观察者间变异性很大，并提出即使专家一致认为这些代表血管痉挛相关性迟发性缺血性神经功能缺损，它们也可能不是血管痉挛严重程度的可靠标志物。
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