Department of Radiology, Naval Medical Center, Portsmouth, VA, United States; Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, United States.
The University of Queensland, Australia.
J Cardiovasc Comput Tomogr. 2018 Mar-Apr;12(2):125-130. doi: 10.1016/j.jcct.2017.11.014. Epub 2017 Dec 5.
The Coronary Artery Disease Reporting and Data System (CAD-RADS) provides a lexicon and standardized reporting system for coronary CT angiography.
To evaluate inter-observer agreement of the CAD-RADS among an panel of early career and expert readers.
Four early career and four expert cardiac imaging readers prospectively and independently evaluated 50 coronary CT angiography cases using the CAD-RADS lexicon. All readers assessed image quality using a five-point Likert scale, with mean Likert score ≥4 designating high image quality, and <4 designating moderate/low image quality. All readers were blinded to medical history and invasive coronary angiography findings. Inter-observer agreement for CAD-RADS assessment categories and modifiers were assessed using intra-class correlation (ICC) and Fleiss' Kappa (κ).The impact of reader experience and image quality on inter-observer agreement was also examined.
Inter-observer agreement for CAD-RADS assessment categories was excellent (ICC 0.958, 95% CI 0.938-0.974, p < 0.0001). Agreement among expert readers (ICC 0.925, 95% CI 0.884-0.954) was marginally stronger than for early career readers (ICC 0.904, 95% CI 0.852-0.941), both p < 0.0001. High image quality was associated with stronger agreement than moderate image quality (ICC 0.944, 95% CI 0.886-0.974 vs. ICC 0.887, 95% CI 0.775-0.95, both p < 0.0001). While excellent inter-observer agreement was observed for modifiers S (stent) and G (bypass graft) (both κ = 1.0), only fair agreement (κ = 0.40) was observed for modifier V (high risk plaque).
Inter-observer reproducibility of CAD-RADS assessment categories and modifiers is excellent, except for high-risk plaque (modifier V) which demonstrates fair agreement. These results suggest CAD-RADS is feasible for clinical implementation.
冠状动脉疾病报告和数据系统（CAD-RADS）为冠状动脉 CT 血管造影提供了词汇和标准化报告系统。
评估一组早期职业和专家读者对 CAD-RADS 的观察者间一致性。
四位早期职业和四位专家心脏成像读者前瞻性地独立使用 CAD-RADS 词汇评估了 50 例冠状动脉 CT 血管造影病例。所有读者均使用 5 分李克特量表评估图像质量，平均李克特评分≥4 表示图像质量高，<4 表示中/低图像质量。所有读者均对病史和血管造影结果进行盲法评估。使用组内相关系数（ICC）和弗莱氏 κ（κ）评估 CAD-RADS 评估类别和修饰符的观察者间一致性。还检查了读者经验和图像质量对观察者间一致性的影响。
CAD-RADS 评估类别的观察者间一致性极好（ICC 0.958，95%置信区间 0.938-0.974，p<0.0001）。专家读者（ICC 0.925，95%置信区间 0.884-0.954）的一致性略高于早期职业读者（ICC 0.904，95%置信区间 0.852-0.941），均 p<0.0001。高质量图像与一致性较强相关，而中质量图像则不相关（ICC 0.944，95%置信区间 0.886-0.974 与 ICC 0.887，95%置信区间 0.775-0.95，均 p<0.0001）。虽然 S（支架）和 G（旁路移植）修饰符（均 κ=1.0）的观察者间一致性极好，但 V（高危斑块）修饰符的一致性仅为一般（κ=0.40）。
CAD-RADS 评估类别和修饰符的观察者间可重复性极好，除高危斑块（修饰符 V）外，一致性一般。这些结果表明 CAD-RADS 可用于临床实施。
