中华放射学杂志
中華放射學雜誌
중화방사학잡지
Chinese Journal of Radiology
2012年
2期
104-109
,共6页
孙明利%吕滨%吴润泽%李世国%荆志成%韩磊%霍衍敏%于方方%蒋世良%戴汝平%吕建华%侯志辉%高扬%曹慧丽%吴永健%杨跃进%乔树宾
孫明利%呂濱%吳潤澤%李世國%荊誌成%韓磊%霍衍敏%于方方%蔣世良%戴汝平%呂建華%侯誌輝%高颺%曹慧麗%吳永健%楊躍進%喬樹賓
손명리%려빈%오윤택%리세국%형지성%한뢰%곽연민%우방방%장세량%대여평%려건화%후지휘%고양%조혜려%오영건%양약진%교수빈
冠状动脉疾病%体层摄影术,X线计算机%冠状血管造影术%评价研究
冠狀動脈疾病%體層攝影術,X線計算機%冠狀血管造影術%評價研究
관상동맥질병%체층섭영술,X선계산궤%관상혈관조영술%평개연구
Coronary disease%Tomography,X-ray computed%Coronary angiography%Evaluation studies
目的 评价不同医师和同一医师前后两次评价有创冠状动脉造影(ICA)和CT冠状动脉成像(CTCA)诊断冠心病(CAD)的可重复性.方法 由水平相当的2名有10年以上经验的副主任医师分别盲法分析42例连续患者的ICA资料；30 d后其中1名医师重复盲法分析ICA资料；同样方法由另2名有10年以上经验的副主任医师分析该42例患者的CTCA资料(数据均由双源CT前瞻性心电门控序列采集),分别比较ICA和CTCA医师间(inter-reader)、两种方法同一医师(intra-reader)诊断CAD的Kappa值、狭窄程度完全一致的比率；以ICA为参考标准评价CTCA诊断CAD的准确性,比较ROC曲线下面积.结果 ICA和CTCA医师间Kappa值分别为0.91和0.81,两种方法同一医师的Kappa值分别为0.92和0.83(x2=509.4和432.5,P值均＜0.01).诊断冠状动脉狭窄程度一致的冠状动脉节段占总评价节段的比率:医师间,ICA为80.8％ (494/611),CTCA为75.2％ (469/624；x2=2.75,P=0.10)；同一医师,ICA为86.9％ (531/611),CTCA为81.9％ (511/624；x2=3.76,P=0.053).以狭窄程度≥50％为诊断CAD标准,诊断一致的节段占总评价节段的比率:医师间,ICA为96.6％( 590/611),CTCA为94.4％( 589/624；x2=3.36,P=0.07)；同一医师,ICA为97.4％(595/611),CTCA为95.4％(595/624；x2=3.62,P=0.06).以ICA为参考标准,CTCA 2名医师共同诊断CAD的敏感性和特异性分别为84.9％(530/624)和98.1％ (612/624),ROC曲线下面积为0.94(95％可信区间为0.91 ～0.97).结论 ICA和CTCA诊断CAD的重复性良好,ICA优于CTCA,不同医师和同一医师前后两次的诊断会出现一定比率的诊断误差.
目的 評價不同醫師和同一醫師前後兩次評價有創冠狀動脈造影(ICA)和CT冠狀動脈成像(CTCA)診斷冠心病(CAD)的可重複性.方法 由水平相噹的2名有10年以上經驗的副主任醫師分彆盲法分析42例連續患者的ICA資料；30 d後其中1名醫師重複盲法分析ICA資料；同樣方法由另2名有10年以上經驗的副主任醫師分析該42例患者的CTCA資料(數據均由雙源CT前瞻性心電門控序列採集),分彆比較ICA和CTCA醫師間(inter-reader)、兩種方法同一醫師(intra-reader)診斷CAD的Kappa值、狹窄程度完全一緻的比率；以ICA為參攷標準評價CTCA診斷CAD的準確性,比較ROC麯線下麵積.結果 ICA和CTCA醫師間Kappa值分彆為0.91和0.81,兩種方法同一醫師的Kappa值分彆為0.92和0.83(x2=509.4和432.5,P值均＜0.01).診斷冠狀動脈狹窄程度一緻的冠狀動脈節段佔總評價節段的比率:醫師間,ICA為80.8％ (494/611),CTCA為75.2％ (469/624；x2=2.75,P=0.10)；同一醫師,ICA為86.9％ (531/611),CTCA為81.9％ (511/624；x2=3.76,P=0.053).以狹窄程度≥50％為診斷CAD標準,診斷一緻的節段佔總評價節段的比率:醫師間,ICA為96.6％( 590/611),CTCA為94.4％( 589/624；x2=3.36,P=0.07)；同一醫師,ICA為97.4％(595/611),CTCA為95.4％(595/624；x2=3.62,P=0.06).以ICA為參攷標準,CTCA 2名醫師共同診斷CAD的敏感性和特異性分彆為84.9％(530/624)和98.1％ (612/624),ROC麯線下麵積為0.94(95％可信區間為0.91 ～0.97).結論 ICA和CTCA診斷CAD的重複性良好,ICA優于CTCA,不同醫師和同一醫師前後兩次的診斷會齣現一定比率的診斷誤差.
목적 평개불동의사화동일의사전후량차평개유창관상동맥조영(ICA)화CT관상동맥성상(CTCA)진단관심병(CAD)적가중복성.방법 유수평상당적2명유10년이상경험적부주임의사분별맹법분석42례련속환자적ICA자료；30 d후기중1명의사중복맹법분석ICA자료；동양방법유령2명유10년이상경험적부주임의사분석해42례환자적CTCA자료(수거균유쌍원CT전첨성심전문공서렬채집),분별비교ICA화CTCA의사간(inter-reader)、량충방법동일의사(intra-reader)진단CAD적Kappa치、협착정도완전일치적비솔；이ICA위삼고표준평개CTCA진단CAD적준학성,비교ROC곡선하면적.결과 ICA화CTCA의사간Kappa치분별위0.91화0.81,량충방법동일의사적Kappa치분별위0.92화0.83(x2=509.4화432.5,P치균＜0.01).진단관상동맥협착정도일치적관상동맥절단점총평개절단적비솔:의사간,ICA위80.8％ (494/611),CTCA위75.2％ (469/624；x2=2.75,P=0.10)；동일의사,ICA위86.9％ (531/611),CTCA위81.9％ (511/624；x2=3.76,P=0.053).이협착정도≥50％위진단CAD표준,진단일치적절단점총평개절단적비솔:의사간,ICA위96.6％( 590/611),CTCA위94.4％( 589/624；x2=3.36,P=0.07)；동일의사,ICA위97.4％(595/611),CTCA위95.4％(595/624；x2=3.62,P=0.06).이ICA위삼고표준,CTCA 2명의사공동진단CAD적민감성화특이성분별위84.9％(530/624)화98.1％ (612/624),ROC곡선하면적위0.94(95％가신구간위0.91 ～0.97).결론 ICA화CTCA진단CAD적중복성량호,ICA우우CTCA,불동의사화동일의사전후량차적진단회출현일정비솔적진단오차.
Objective To investigate the intra- and interobserver repeatability of coronary artery disease (CAD) diagnosis based on invasive coronary angiography (ICA) and CT coronary angiography (CTCA).Methods Two readers with comparable experience ( over 10 years) independently evaluated ICA results of 42 consecutive patients with a blind method. After 30 days,one of them reviewed the same patients again.Another two comparable-experience (over 10 years) readers evaluated the results of CTCA (prospectively ECG-triggering) from the same 42 patients in the same way.The inter-reader and intra-reader repeatability of ICA and CTCA were analyzed by performing Kappa test and calculating the percentage of the segments with agreement on stenotic degree.Using ICA as reference,the accuracy of CTCA in diagnosing CAD was studied by comparing the area under ROC. Results The Kappa between readers for ICA and CTCA were 0.91 and 0.81.Intra-reader Kappa were 0.92 and 0.83 respectively (x2 =509.4 and 432.5,all P ＜0.01 ).The percentage of the segments with agreement between readers on the degree of stenosis were 80.8％ (494/611) in ICA and 75.2％ (469/624) in CTCA ( x2 =2.75,P =0.10),and within the same reader,86.9％ (531/611)in ICA and 81.9％ (511/624) in CTCA(x2 =3.76,P =0.053).With≥ 50％narrowing as a CAD diagnosis criterion,the agreement rates for two readers were 96.6％ (590/611 ) in ICA and 94.4％ (589/624) in CTCA( x2 =3.36,P =0.07),and for the same reader,97.4％ (595/611) in ICA,95.4％ (595/624) in CTCA ( x2 =3.62,P =0.06).Using ICA as reference,two readers of CTCA results achieved a sensitivity and specificity of 84.9％ (530/624)and 98.1％ (612/624).The area under ROC was 0.94 (95％ CI 0.91-0.97).Conclusions Both ICA and CTCA demonstrate good repeatability in diagnosing CAD.The repeatability of ICA is superior to that of CTCA.A certain discrepancy exists in two readings from the same reader or two readers.
