Tourassi G D, Floyd C E, Coleman R E
Department of Diagnostic Radiology, University of Louisville Hospital, Kentucky, USA.
Radiology. 1998 Jan;206(1):81-8. doi: 10.1148/radiology.206.1.9423655.
To evaluate the cost-effectiveness of artificial neural networks for diagnosis in patients suspected of having acute pulmonary embolism who are typically referred for pulmonary angiography.
Four diagnostic strategies were explored to help define the diagnostic role of neural networks in patients suspected of having pulmonary embolism in whom nondiagnostic ventilation-perfusion lung scans were obtained. First, a network was used to determine which patients could be directly referred for treatment without angiography. Second, the network was applied to determine in which patients treatment could be withheld. Third, the network was used to distinguish patients in whom the network gave indeterminate responses and who should proceed to angiography. Each strategy was compared with use of angiography in terms of morbidity, mortality, and cost per life saved.
The use of the neural network reduced the average cost per patient by more than one-half relative to the cost of angiography. Morbidity and mortality rates were also comparable to or lower than those associated with angiography. The results were consistent regardless of the prevalence of disease.
The use of neural networks in the diagnosis of pulmonary embolism is a promising way to improve cost-effectiveness in the care of patients with nondiagnostic lung scans.
评估人工神经网络对疑似急性肺栓塞且通常需接受肺血管造影检查的患者进行诊断的成本效益。
探讨了四种诊断策略，以帮助确定神经网络在获得非诊断性通气灌注肺扫描结果的疑似肺栓塞患者中的诊断作用。首先，使用一个网络来确定哪些患者可以直接接受治疗而无需进行血管造影。其次，应用该网络来确定哪些患者可以暂停治疗。第三，该网络用于区分那些网络给出不确定反应且应进行血管造影的患者。将每种策略在发病率、死亡率和每挽救一条生命的成本方面与使用血管造影进行了比较。
相对于血管造影的成本，使用神经网络使每位患者的平均成本降低了一半以上。发病率和死亡率也与血管造影相关的发病率和死亡率相当或更低。无论疾病的患病率如何，结果都是一致的。
在肺栓塞诊断中使用神经网络是提高对非诊断性肺扫描患者护理成本效益的一种有前景的方法。
