Intra- and interobserver reproducibility in the assessment of coronary artery disease: evaluation with invasive coronary angiography and CT coronary angiography
SUN Ming-li, L(U) Bin, LI Shi-guo, HAN Lei, HUO Yan-min, YU Fang-fang, JIANG Shi-liang, DAI Ru-ping, LU Jian-hua, HOU Zhi-hui, GAO Yang, CAO Hui-li
Published 2012-02-10
Cite as Chin J Radiol, 2012,46(02): 104-109. DOI: 10.3760/cma.j.issn.1005-1201.2012.02.002
Abstract
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.
Key words:
Coronary disease; Tomography, X-ray computed; Coronary angiography; Evaluation studies
Contributor Information
SUN Ming-li
Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College,Chinese Academy of Medical Sciences, Beijing 100037, China
L(U) Bin
Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College,Chinese Academy of Medical Sciences, Beijing 100037, China
LI Shi-guo
Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College,Chinese Academy of Medical Sciences, Beijing 100037, China
HAN Lei
Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College,Chinese Academy of Medical Sciences, Beijing 100037, China
HUO Yan-min
Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College,Chinese Academy of Medical Sciences, Beijing 100037, China
YU Fang-fang
Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College,Chinese Academy of Medical Sciences, Beijing 100037, China
JIANG Shi-liang
Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College,Chinese Academy of Medical Sciences, Beijing 100037, China
DAI Ru-ping
Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College,Chinese Academy of Medical Sciences, Beijing 100037, China
LU Jian-hua
Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College,Chinese Academy of Medical Sciences, Beijing 100037, China
HOU Zhi-hui
Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College,Chinese Academy of Medical Sciences, Beijing 100037, China
GAO Yang
Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College,Chinese Academy of Medical Sciences, Beijing 100037, China
CAO Hui-li
Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College,Chinese Academy of Medical Sciences, Beijing 100037, China