Tuberc Respir Dis > Volume 59(5); 2005 > Article
Tuberculosis and Respiratory Diseases 2005;59(5):473-479.
DOI: https://doi.org/10.4046/trd.2005.59.5.473    Published online November 1, 2005.
A Study of Inter-observer Agreements of Spiral Chest Computed Tomography in Diagnosing Pulmonary Embolism.
Yang Ki Kim, 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
1Division of Respiratory & Allergy Medicine, Department of Internal Medicine, Soonchunhyang University, School of Medicine, Seoul, Korea. uhs@hosp.sch.ac.kr
2Department of Radiology, Soonchunhyang University, School of Medicine, Seoul, Korea.
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.
Key Words: Pulmonary Embolism, Spiral CT, Accordance between observers


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