Rajebi Mohammad Reza, Benenati Matthew J, Schernthaner Melanie B, Walker Gail, Gandhi Ripal T, Pena Constantino S, Katzen Barry T
Miami Cardiac and Vascular Institute, Miami, Florida; Department of Radiology, Division of Vascular and Interventional Radiology, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905.
Miami Cardiac and Vascular Institute, Miami, Florida.
J Vasc Interv Radiol. 2015 Jun;26(6):890-6. doi: 10.1016/j.jvir.2015.02.018. Epub 2015 Apr 3.
To evaluate reliability, accuracy, and agreement of simple visual estimation (SVE) in determining the degree of peripheral arterial stenosis compared with calibrated measurements.
In 2 sessions, 23 interventionists with a wide range of experience and subspecialty training reviewed 42 angiographic images of lower extremity and carotid arteries (21 iliofemoral arteries and 21 carotid arteries). An independent physician measured all lesions using manual calipers. Intrarater and interrater reliability were assessed by intraclass correlation. A ± 5% error was considered the threshold for accuracy, and weighted κ statistics were computed to assess agreement with respect to the degree of stenosis (< 50%, nonsignificant; 50%-80%, significant; > 80%, severe).
Intrarater reliability of SVE was 0.99, and interrater reliability was 0.83. Accuracy varied from 52.8% for images of severe stenosis to 26.5% and 18.1% for significant and nonsignificant stenosis, respectively (P < .001). Agreement between SVE and caliper with regard to degree of stenosis was good (weighted κ 0.56) overall with correct classification ranging from 92.6% for severe stenosis to 53.4% and 68.2% for significant and nonsignificant stenosis, respectively (P < .001). Misclassification of nonsignificant and significant stenosis was more frequent for carotid arteries than for lower extremities.
Despite high reliability, SVE of peripheral arterial stenosis has limited accuracy in determining the exact degree of stenosis. Although severe stenosis is readily identified by SVE, arterial stenosis of < 80% is frequently overestimated, especially for carotid arteries, and should be confirmed by caliper assessment.
评估与校准测量相比，简单视觉估计（SVE）在确定外周动脉狭窄程度方面的可靠性、准确性和一致性。
在两个阶段中，23名具有广泛经验和亚专业培训的介入医师对42张下肢和颈动脉（21条髂股动脉和21条颈动脉）的血管造影图像进行了评估。一名独立的医生使用手动卡尺测量所有病变。通过组内相关系数评估评分者内和评分者间的可靠性。将±5%的误差视为准确性阈值，并计算加权κ统计量以评估在狭窄程度方面的一致性（<50%，无意义；50%-80%，有意义；>80%，严重）。
SVE的评分者内可靠性为0.99，评分者间可靠性为0.83。准确性从严重狭窄图像的52.8%到有意义和无意义狭窄图像的26.5%和18.1%不等（P<.001）。总体而言，SVE与卡尺在狭窄程度方面的一致性良好（加权κ为0.56），正确分类率从严重狭窄的92.6%到有意义和无意义狭窄的53.4%和68.2%不等（P<.001）。颈动脉非显著和显著狭窄的错误分类比下肢更频繁。
尽管可靠性高，但外周动脉狭窄的SVE在确定确切狭窄程度方面准确性有限。虽然SVE能轻易识别严重狭窄，但<80%的动脉狭窄常被高估，尤其是颈动脉，应通过卡尺评估予以确认。
