疑似急性心肌梗死患者的锝-99m焦磷酸盐闪烁扫描：观察者间变异性的影响

Technetium-99m-pyrophosphate scintigraphy in patients with suspected acute myocardial infarction: impact of interobserver variability.

作者信息

Fisher M L, Kelemen M H, Collins D, Holder L, Winzelberg G, Plotnick G D, Morris F, Moran G W, Carliner N H, Peters R W

出版信息

Am Heart J. 1985 Aug;110(2):347-52. doi: 10.1016/0002-8703(85)90155-3.

Abstract

Technetium-99m-pyrophosphate (TcPYP) scintigraphy may have great value in patients with suspected acute myocardial infarction (AMI), but interobserver variability undoubtedly has adverse impact on predictive value. TcPYP scintigrams for 133 (80%) of 166 consecutive patients admitted for suspected AMI were interpreted independently by three experienced readers. Although there was complete agreement for 87 interpretations (65%), major discrepancies (i.e., at least one positive and one negative reading on the same scan) occurred for 28 scans (21%). To assess predictive accuracy, patients were categorized as follows: 36 had definite AMI manifest by new ECG Q waves and/or CK-MB evidence of AMI (group I), 56 were classified as possible AMI (group II), and 41 had AMI excluded (group III). Using only the definitive diagnostic categories (groups I and III), accuracy for each reader approximated 0.68, with no single reader being correct more often than any other.

摘要

锝-99m焦磷酸盐（TcPYP）闪烁扫描术对于疑似急性心肌梗死（AMI）的患者可能具有重要价值，但观察者间的差异无疑会对预测价值产生不利影响。166例因疑似AMI入院的连续患者中，133例（80%）的TcPYP闪烁扫描图由三位经验丰富的阅片者独立解读。尽管87次解读（65%）完全一致，但28次扫描（21%）出现了重大差异（即同一次扫描至少有一次阳性和一次阴性解读）。为评估预测准确性，患者被分类如下：36例有新出现的心电图Q波和/或CK-MB提示AMI的明确AMI（I组），56例被分类为可能AMI（II组），41例排除AMI（III组）。仅使用明确的诊断类别（I组和III组），每位阅片者的准确率约为0.68，没有一位阅片者的正确次数比其他阅片者更多。