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首页> 外文期刊>Journal of hypertension >Inter-observer variability in the angiographic assessment of renal artery stenosis. DRASTIC study group. Dutch Renal Artery Stenosis Intervention Cooperative.
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Inter-observer variability in the angiographic assessment of renal artery stenosis. DRASTIC study group. Dutch Renal Artery Stenosis Intervention Cooperative.

机译：肾动脉狭窄的血管造影评估中观察者间的差异。 DRASTIC研究小组。荷兰肾动脉狭窄干预合作社。

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OBJECTIVE: To assess inter-observer agreement in the interpretation of renal angiograms. DESIGN: Comparison of the assessment of renal angiograms by three experienced radiologists, who evaluated the number of renal arteries and the presence, location, aspect and severity of a renal artery stenosis. SETTING: General hospital and university hospital serving urban and rural populations. PATIENTS: Patients with difficult-to-treat hypertension referred for diagnostic work-up; 312 angiograms with the intra-arterial digital subtraction technique were obtained from 289 consecutive patients. MAIN OUTCOME MEASURES: Inter-observer agreement was tested for the following parameters: number of arteries per kidney, presence of stenosis, location of stenosis (truncal, ostial), aspect of stenosis (concentric, eccentric, post-stenotic dilatation), severity of stenosis (reduction of lumen diameter in categories of 30%, 40%, etc. to 100%), and overall quality of the angiographic images. Kappa (kappa) values and weighted kappa between the three pairs of radiologists were used as estimates of inter-observer agreement RESULTS: Agreement about the number of renal arteries was reasonable (kappa = 0.50-0.72), as was agreement about the presence of stenosis (kappa = 0.68-0.86). Agreement about stenosis location and aspect was poor (kappa = 0.26-0.47 and kappa = 0.15-0.26, respectively). There was general agreement about the severity of stenosis (weighted kappa = 0.65-0.70), but it was not possible to distinguish between 50 and 60% stenosis or between 60 and 70% stenosis (kappa < 0.40). No correlation was found between agreement on severity of stenosis and the quality of the images. CONCLUSIONS: It is not realistic to make statements about what degree of renal artery stenosis is clinically significant, as long as the intra-arterial angiogram with digital subtraction remains the gold standard. It is likewise risky to rely too strongly on stenosis morphology as visualized by renal angiography in choosing between balloon angioplasty and stent deployment.
机译：目的：评估观察者之间在解释肾血管造影方面的一致性。设计：由三位经验丰富的放射科医生对肾血管造影的评估进行比较，他们评估了肾动脉的数量以及肾动脉狭窄的存在，位置，长短和严重程度。地点：为城市和农村人口服务的综合医院和大学医院。患者：患有难治性高血压的患者接受诊断检查。从289位连续患者中获得了312幅血管内数字减影技术的血管造影照片。主要观察指标：对观察者之间的一致性进行以下参数测试：每个肾脏的动脉数，狭窄的存在，狭窄的位置（横断面，眼口），狭窄的方面（同心，偏心，狭窄后扩张），严重程度狭窄（将管腔直径缩小30％，40％等至100％），以及血管造影图像的整体质量。三对放射线医师之间的卡伯值和加权卡伯值被用作观察者之间一致性的评估结果：关于肾动脉数目的一致性是合理的（kappa = 0.50-0.72），对于存在狭窄的一致性也是合理的（k = 0.68-0.86）。狭窄部位和长宽比的一致性差（kappa = 0.26-0.47和kappa = 0.15-0.26）。对于狭窄的严重程度已达成普遍共识（加权κ= 0.65-0.70），但无法区分狭窄程度为50％至60％还是狭窄程度为60％至70％（kappa <0.40）。在狭窄严重程度的一致性与图像质量之间未发现相关性。结论：只要数字减影的动脉内血管造影仍然是金标准，就陈述什么程度的肾动脉狭窄具有临床意义是不现实的。在球囊血管成形术和支架置入之间进行选择时，过于依赖狭窄形态（如肾血管造影所显示）也是有风险的。

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