Diffin D C, Leyendecker J R, Johnson S P, Zucker R J, Grebe P J
Department of Radiology, MTRD, Wilford Hall Medical Center, Lackland Air Force Base, TX 78236-5300, USA.
AJR Am J Roentgenol. 1998 Oct;171(4):1085-9. doi: 10.2214/ajr.171.4.9763002.
This study examines the anatomic distribution of emboli on pulmonary angiography and attempts to determine the relationship of vessel size to interobserver agreement, two factors having important implications in comparing pulmonary angiography with cross-sectional imaging for pulmonary embolism.
One hundred twenty-five consecutive pulmonary angiograms were reviewed retrospectively by three interventional radiologists. Initial interpretations were recorded and compared to determine interobserver agreement on a per-patient and per-embolus basis. Discordant interpretations were reviewed by all radiologists for a consensus interpretation.
Unanimous per-patient agreement occurred in 91% (114/125) of initial interpretations. The largest artery containing acute pulmonary embolism was segmental or larger in 24 patients (83% of patients with acute positive findings, 19% of all patients) and subsegmental in only five patients (17% and 4%, respectively). On a per-patient basis, initial interobserver agreement averaged 45% and unanimous consensus agreement was achieved for 79% of patients having isolated subsegmental pulmonary embolism. Consensus readings altered initial per-patient interpretations for 30% of patients having only subsegmental pulmonary embolism; per-embolus interpretations were altered for 37% of all subsegmental emboli.
Subsegmental emboli occurring as isolated findings are relatively rare. Approximately one third of subsegmental emboli and one third of patients having isolated subsegmental emboli may be initially misdiagnosed on pulmonary angiography. Objections to cross-sectional imaging for pulmonary embolism based on the inability to detect subsegmental pulmonary embolism when compared with pulmonary angiography should be reexamined with this data in mind.
本研究检查了肺血管造影中栓子的解剖分布，并试图确定血管大小与观察者间一致性的关系，这两个因素在比较肺血管造影与用于肺栓塞的横断面成像时具有重要意义。
三位介入放射科医生对125例连续的肺血管造影片进行了回顾性分析。记录初始解读结果，并在患者个体和每个栓子的基础上比较以确定观察者间的一致性。所有放射科医生对有分歧的解读进行复查以达成共识解读。
初始解读中91%（114/125）的患者个体间达成了一致。24例患者中包含急性肺栓塞的最大动脉为节段性或更大（占急性阳性结果患者的83%，占所有患者的19%），仅5例患者为亚段性（分别占17%和4%）。在患者个体基础上，初始观察者间一致性平均为45%，对于仅有亚段性肺栓塞的患者，79%达成了一致的共识解读。对于仅有亚段性肺栓塞的患者，30%的患者个体初始解读因共识解读而改变；所有亚段性栓子中，37%的栓子解读因共识解读而改变。
孤立出现的亚段性栓子相对少见。大约三分之一的亚段性栓子和三分之一仅有亚段性栓子的患者在肺血管造影时可能最初被误诊。基于与肺血管造影相比无法检测到亚段性肺栓塞而对用于肺栓塞的横断面成像提出的异议，应结合这些数据重新审视。
