A Study of Inter-observer Agreements of Spiral Chest Computed Tomography in Diagnosing Pulmonary Embolism.
10.4046/trd.2005.59.5.473
- Author:
Yang Ki KIM
1
;
Young Mok LEE
;
Ki up KIM
;
Soo taek UH
;
Yong Hoon KIM
;
Choon Sik PARK
;
Jung Hwa HWANG
;
Dong Hun KIM
;
Dong Erk GOO
;
Deuk Lin CHOI
Author Information
1. Division of Respiratory & Allergy Medicine, Department of Internal Medicine, Soonchunhyang University, School of Medicine, Seoul, Korea. uhs@hosp.sch.ac.kr
- Publication Type:Original Article
- Keywords:
Pulmonary Embolism;
Spiral CT;
Accordance between observers
- MeSH:
Arteries;
Delayed Diagnosis;
Diagnosis;
Humans;
Pulmonary Artery;
Pulmonary Embolism*;
Thorax*;
Thrombosis;
Tomography, Spiral Computed;
Tomography, X-Ray Computed
- From:Tuberculosis and Respiratory Diseases
2005;59(5):473-479
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: A pulmonary embolism often presents with nonspecific symptoms and signs. However, a delayed diagnosis can result in catastrophic outcome. The majority of preventable deaths associated with a pulmonary embolism can be ascribed to a missed diagnosis rather than to the failure of existing treatments. Therefore, accurate and rapid diagnostic methods are essential for the management of a pulmonary embolism. The recent generation of multidetector-row spiral CT scanners appears to outperform other imaging modalities in detecting a central and peripheral pulmonary embolism. However, there are some variations in the interpretations of the findings between observers. This study examined the inter-observer differences of the diagnoses in patients with a pulmonary embolism. METHOD: 64 patients who were diagnosed with a pulmonary embolism either clinically or with spiral chest CT from 2002 to 2004, were included. Two thoracic radiologists interpreted the multidetector-row spiral CT in terms of the diagnosis of a pulmonary embolism and the location of the thrombus independently. Among 64 patients, 14 patients were excluded because there was no evidence of a pulmonary embolism or there was different interpretation of the pulmonary embolism between radiologists. A clinical diagnosis was based on "Rules for predicting the probability of embolism". RESULTS: The mean score of the patients according to the Wells method was 3.91 +/- 0.30 (0-9). The accordance of the radiologists was 95% in the main, 85% in the lobar, 91.2% in the segmental, and 96% in the sub-segmental pulmonary arteries. After excluding the negative interpretation from both radiologists, their agreement was 76.2%(kappa: 0.83) in the main, 57.6%(kappa: 0.63) in the lobar, 51.5%(kappa: 0.63) in the segmental, and 34.6%(kappa: 0.49) in the sub-segmental pulmonary arteries. CONCLUSION: Chest CT has been recently applied to patients suspected of having a pulmonary embolism. It was found that spiral CT is a rapid test for diagnosing a thrombus, and there was reliable accordance between the observers from the area of the large pulmonary arteries. However, there was a lack of agreement between the observers in diagnosing thrombi located distal to the sub-segmental arteries.
