动脉内血管造影解读中的观察者差异以及颈动脉内膜切除术不恰当决策的风险。

Observer variation in the interpretation of intra-arterial angiograms and the risk of inappropriate decisions about carotid endarterectomy.

作者信息

Young G R, Sandercock P A, Slattery J, Humphrey P R, Smith E T, Brock L

机构信息

Walton Centre for Neurology and Neurosurgery, Liverpool, UK.

出版信息

J Neurol Neurosurg Psychiatry. 1996 Feb;60(2):152-7. doi: 10.1136/jnnp.60.2.152.

DOI:10.1136/jnnp.60.2.152

PMID:8708644

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC1073795/

Abstract

OBJECTIVE

To determine how often observer variation in the interpretation of intra-arterial angiograms might alter the decision whether or not to refer patients for carotid surgery.

METHODS

A prospective study was carried out in a consecutive series of 99 patients with transient ischaemic attacks and minor strokes. Interpretable angiographic films were available for 179 carotid artery bifurcations. Stenosis of the internal carotid artery was measured using mm scales, independently by three different radiologists (A, B, and C), using the European Carotid Surgery Trial method.

RESULTS

An analysis of the grouped data showed good to moderate agreement by kappa statistics for radiologists A v B, B v C, and A v C of 0.68, 0.60, and 0.70 respectively. The mean absolute difference in the estimate of stenosis by each of the different radiologists (interobserver variation) was 9.5% and for each radiologist on two separate occasions (intraobserver variation) 8.4%. The degree of observer error was smallest among severely stenosed arteries. Although the absolute differences were small, "clinically important" differences which could change the treatment recommended from surgery to no surgery (or vice versa) occurred between radiologists A and B, B and C, and A and C in: seven (3.9%), six (3.4%), and 11 (6.1%) vessels respectively.

CONCLUSIONS

Because observer variation affects all of the imaging methods (Doppler, duplex, contrast arteriography, and MR angiography) used to select patients with transient ischaemic attack and stroke, these findings are likely to be widely relevant. Any centre assessing patients with cerebrovascular disease will need to implement strict quality control measures in the interpretation of angiograms (and other vascular imaging procedures) to minimise observer error and thereby reduce the number of inappropriate decisions made to refer for carotid artery surgery or not.

摘要

目的

确定动脉内血管造影解读过程中观察者差异改变是否将患者转诊至颈动脉手术决策的频率。

方法

对连续的99例短暂性脑缺血发作和轻度卒中患者进行前瞻性研究。可获得179个颈动脉分叉处的可解读血管造影胶片。由三名不同的放射科医生（A、B和C）使用欧洲颈动脉外科试验方法，独立地用毫米尺度测量颈内动脉狭窄情况。

结果

对分组数据的分析显示，放射科医生A与B、B与C、A与C之间的kappa统计一致性良好至中等，分别为0.68、0.60和0.70。不同放射科医生对狭窄估计的平均绝对差异（观察者间差异）为9.5%，每位放射科医生在两个不同时间的差异（观察者内差异）为8.4%。在严重狭窄的动脉中观察者误差程度最小。尽管绝对差异较小，但放射科医生A与B、B与C、A与C之间在以下情况中出现了可能改变推荐治疗方案（从手术到非手术，或反之）的“具有临床重要性”的差异：分别有7条血管（3.9%）、6条血管（3.4%）和11条血管（6.1%）。

结论

由于观察者差异影响用于选择短暂性脑缺血发作和卒中患者的所有成像方法（多普勒、双功超声、造影动脉造影和磁共振血管造影），这些发现可能具有广泛的相关性。任何评估脑血管疾病患者的中心都需要在血管造影（和其他血管成像程序）解读中实施严格的质量控制措施，以尽量减少观察者误差，从而减少在是否转诊至颈动脉手术方面做出的不适当决策数量。