Fridh Erik Baubeta, Ludwigs Karin, Svalkvist Angelica, Andersson Manne, Nordanstig Joakim, Falkenberg Mårten, Johnsson Åse A
Diagnostic Radiology, Department of Translational Medicine, Lund University, Skåne University Hospital, 22185 Lund, Sweden.
Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 41296 Gothenburg, Sweden.
Diagnostics (Basel). 2020 Oct 31;10(11):892. doi: 10.3390/diagnostics10110892.
This paper aimed to study the agreement and repeatability, both intra- and interobserver, of infrapopliteal lesion assessment with magnetic resonance angiography (MRA), using the TransAtlantic Inter-Society Consensus (TASC) II criteria, with perioperative digital subtraction angiography (DSA) as a reference. Sixty-eight patients with an MRA preceding an endovascular infrapopliteal revascularization were included. Preoperative MRAs and perioperative DSAs were evaluated in random order by three independent observers using the TASC II classification. The results were analyzed using visual grading characteristics (VGC) analysis and Krippendorff's α. No systematic difference was found between modalities: area under the VGC curve (AUC) = 0.48 ( = 0.58) or intraobserver; AUC for Observer 1 and 2 respectively, 0.49 ( = 0.85) and 0.53 ( = 0.52) for MRA compared with 0.54 ( = 0.30) and 0.49 ( = 0.81) for DSA. Interobserver differences were seen: AUC of 0.63 ( < 0.01) for DSA and 0.80 ( < 0.01) for MRA. These results were confirmed using Krippendorff's α for the three observers showing 0.13 (95% confidence interval (CI) -0.07-0.31) for MRA and 0.39 (95% CI 0.23-0.53) for DSA. Poor interobserver agreement was also found in the choice of a target vessel on preoperative MRA: Krippendorff's α = 0.19 (95% CI 0.01‒0.36). In conclusion, infrapopliteal lesions can be reliably determined on preoperative MRA, but interobserver variability regarding the choice of a target vessel is a major concern that appears to affect the overall TASC II grade.
本文旨在以围手术期数字减影血管造影（DSA）为参照，采用跨大西洋两岸多协会共识（TASC）II标准，研究磁共振血管造影（MRA）评估腘动脉以下病变时观察者内和观察者间的一致性及可重复性。纳入68例行腘动脉以下血管腔内血运重建术前接受MRA检查的患者。由三名独立观察者按照随机顺序，采用TASC II分类法对术前MRA和围手术期DSA进行评估。使用视觉分级特征（VGC）分析和克里彭多夫α系数对结果进行分析。两种检查方式之间未发现系统性差异：VGC曲线下面积（AUC）=0.48（观察者内为0.58）；观察者1和观察者2对MRA的AUC分别为0.49（P=0.85）和0.53（P=0.52），而DSA的AUC分别为0.54（P=0.30）和0.49（P=0.81）。观察者间存在差异：DSA的AUC为0.63（P<0.01），MRA的AUC为0.80（P<0.01）。对三名观察者使用克里彭多夫α系数证实了这些结果，MRA为0.13（95%置信区间（CI）-0.07-0.31），DSA为0.39（95%CI 0.23-0.53）。在术前MRA上选择目标血管时，观察者间一致性也较差：克里彭多夫α系数=0.19（95%CI 0.01‒0.36）。总之，术前MRA能够可靠地确定腘动脉以下病变，但观察者间在选择目标血管方面的变异性是一个主要问题，似乎会影响整体TASC II分级。
