冗余神经血管成像：该怪谁，又有何价值？
Redundant Neurovascular Imaging: Who Is to Blame and What Is the Value?
机构信息
From the Russell H. Morgan Department of Radiology and Radiological Science (E.B., S.S., R.J., D.M.Y.), Johns Hopkins Medical Institution, Baltimore, Maryland.
Department of Radiology (S.E.), University of Texas Health Science Center, San Antonio, Texas.
出版信息
AJNR Am J Neuroradiol. 2020 Jan;41(1):35-39. doi: 10.3174/ajnr.A6329. Epub 2019 Dec 5.
BACKGROUND AND PURPOSE
Excessive use of neurovascular imaging studies such as Doppler ultrasound, CTA, MRA, and DSA adds cost to the evaluation of patients with new neurologic deficits. We sought to determine to what extent redundant neurovascular imaging is generated by radiologists' recommendations and the agreement rates among modalities in this setting.
MATERIALS AND METHODS
The radiology reports of 300 consecutive patients admitted for acute stroke to determine the frequency of the following: 1) >1 neurovascular study performed, 2) recommendation for another study, 3) recommendation made by the radiologist, and 4) agreement rates among these redundant neurovascular imaging studies.
RESULTS
Among the 300 consecutive patients, 125 had redundant neurovascular imaging, accounting for 144 redundant studies. These included 75/125 redundant neurovascular imaging studies after MRA, 48/125 after CTA, and 2/125 after Doppler ultrasound. The radiologist recommended another vascular study in 22/125 (17.6%) patients; the rest of the recommendations were made by clinicians. The second study agreed with the first in 54.6% (12/22) of cases recommended by radiologists and 73.8% (76/103) recommended by clinicians ( value = .06). CTA agreed with MRA, carotid Doppler ultrasound, and DSA in 66.7%, 66.7%, and 55.6%, respectively. MRA agreed with Doppler ultrasound and DSA in 78.3% and 66.7%, respectively.
CONCLUSIONS
Of cases with redundant neurovascular imaging, most were generated by clinicians, but radiologists recommended redundant neurovascular imaging in 17.6% of patients; 81.8% occurred following MRA. Overall, most secondary studies (68.8%) confirmed the findings of the first study. Such low-value, same-result redundant neurovascular imaging was more common when clinicians ordered the studies (73.8%) than when radiologists ordered them (54.6%).
背景与目的
过多使用神经血管成像研究，如多普勒超声、CTA、MRA 和 DSA，会增加评估新发神经功能缺损患者的成本。我们旨在确定放射科医生的建议在多大程度上产生了冗余的神经血管成像，以及在这种情况下各种成像方式之间的符合率。
材料与方法
对 300 例连续因急性卒中入院的患者的放射学报告进行回顾性分析，以确定以下情况的发生频率：1）进行了 >1 项神经血管研究；2）推荐进行另一项研究；3）放射科医生的建议；4）这些冗余神经血管成像研究之间的符合率。
结果
在 300 例连续患者中，有 125 例存在冗余的神经血管成像，共计 144 项冗余研究。这些包括 MRA 后 75/125 项冗余神经血管成像研究、CTA 后 48/125 项、多普勒超声后 2/125 项。放射科医生建议进行另一项血管研究的有 22/125（17.6%）患者；其余建议由临床医生提出。在放射科医生推荐的 22 项建议中，第二项研究与第一项研究相符的占 54.6%（12/22），而临床医生推荐的 73.8%（76/103）相符（ value =.06）。CTA 与 MRA、颈动脉多普勒超声和 DSA 的符合率分别为 66.7%、66.7%和 55.6%。MRA 与多普勒超声和 DSA 的符合率分别为 78.3%和 66.7%。
结论
在存在冗余神经血管成像的病例中，大多数是由临床医生产生的，但放射科医生在 17.6%的患者中建议进行冗余的神经血管成像；其中 81.8%是在 MRA 后进行的。总体而言，大多数（81.8%）次要研究证实了第一项研究的发现。当临床医生下达检查医嘱时（73.8%），这种低价值、结果相同的冗余神经血管成像比放射科医生下达检查医嘱时（54.6%）更为常见。
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