OBSERVER VARIABILITY IN ECHO-DOPPLER MEASUREMENTS OF PORTAL FLOW IN CIRRHOTIC-PATIENTS AND NORMAL VOLUNTEERS
OBSERVER VARIABILITY IN ECHO-DOPPLER MEASUREMENTS OF PORTAL FLOW IN CIRRHOTIC-PATIENTS AND NORMAL VOLUNTEERS
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DOI：
10.1016/0016-5085(90)91097-p
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发表时间：
1990-06-01
期刊：
影响因子：
29.4
通讯作者：
GROSZMANN, RJ
中科院分区：
文献类型：
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作者：
SABBA, C;WELTIN, GG;GROSZMANN, RJ
在一项盲法对照研究中，评价了回声-多普勒法测量门静脉血流的观察者内和观察者间的变异性。2名熟练操作人员在1~3mo内对22例肝硬变患者和14例正常志愿者(6例肝硬变患者和7例正常志愿者)进行了双功多普勒检查。测量面积、平均流速和流量(4个测量值：第1天的A、B；第2天的C、D)。使用组内相关系数来评估观察者内和观察者间对这三个参数测量的一致性的统计学意义和临床意义。通过同一天的两次测量和连续几天同一时间的两次测量，获得正常受试者和肝硬化症患者每个参数的观察者内部一致性水平。还计算了四种测量结果之间的总体一致性。通过分别计算两名观察员在相同的2天期间对同一物体进行的四对测量中的每一对的组内相关系数，获得观察员之间的一致程度。变异系数也被用来比较这些测量中的变异性。总体而言，观察者1的观察者对正常受试者的一致性从好到优，观察者2的一致性从一般到良好。对于肝硬变患者，观察者1在所有参数上都是优秀的。观察者2的组内相关系数值较低，尤其是连续几天的速度。在两位门脉血流观察者中，肝硬变患者的变异系数在2%-30%之间，平均为+-。扫描电子显微镜为12%。+-。4%。在两个样本中的任何一个样本中，都没有发现两个观察员之间可以接受的观察者间协议。这些结果支持这项技术主要用于确定门静脉血流动力学在短时间内的快速和大的变化。这项技术在监测门静脉血流动力学的慢性变化方面似乎精确度较低。
The intraobserver and interobserver variability in measuring the portal vein flow by the echo-Doppler technique was evaluated in a blind controlled study. A total of 22 cirrhotic patients and 14 normal volunteers were examined by two skilled operators using duplex Doppler within a period of 1-3 mo (6 cirrhotics and 7 normal volunteers by both observers). Area, mean velocity, and flow were measured (4 measurements: A, B on day 1; C, D on day 2). The intraclass correlation coefficient was used to assess both the statistifal and clinical significance of intraobserver and interobserver agreement for the measurements of these three parameters. The level of intraobserver agreement for each parameter on normal subjects and cirrhotics was obtained from the two measurements on the same day and from the two measurements at the same time on consecutive days. Overall agreement between the four measurements was also calculated. Levels of interobserver agreement were obtained by calculating separately the intraclass correlation coefficient from each of the four pairs of measurements made on the same object by the two observers over the same period of 2 days. The coefficient of variations was also used to compare the variability in these measurements. Overall, intraobserver agreement on normal subjects varied from good to excellent for observer 1, and from fair to good for observer 2. On cirrhotic patients, observer 1 was excellent at all times for all parameters. Observer 2 had lower intraclass correlation coefficient values, especially for velocity on consecutive days. For the best of the two observers on the portal flow, the coefficient of variation in cirrhotic patients ranged from 2%-30% with a mean .+-. SEM of 12% .+-. 4% . No acceptable interobserver agreement was found between the two observers in either of the two samples of subjects. These results support the use of this technique mainly for the determination of rapid and large changes in portal hemodynamics within a short period of time. The technique seems to have low precision in monitoring chronic changes in portal hemodynamics.