Identification of Coronary Plaque Sub-Types Using Virtual Histology Intravascular Ultrasound Is Affected by Inter-Observer Variability and Differences in Plaque Definitions
Identification of Coronary Plaque Sub-Types Using Virtual Histology Intravascular Ultrasound Is Affected by Inter-Observer Variability and Differences in Plaque Definitions
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DOI：
10.1161/circimaging.111.965442
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发表时间：
2012-01-01
影响因子：
7.5
通讯作者：
Bennett, Martin R.
中科院分区：
文献类型：
--
作者：
Obaid, Daniel R.;Calvert, Patrick A.;Bennett, Martin R.
背景-最近的研究表明，虚拟组织学血管内超声（VH-IVUS）可以识别高破裂风险的斑块，如薄帽纤维动脉粥样硬化，提高了立即靶向干预的可能性。然而，斑块分类需要边界识别和斑块结构的主观评估，从而在未经核心实验室确认的情况下引入观察者间的差异性。此外，当地与核心实验室VH-IVUS斑块分类和不同的斑块definitions.Methods和结果的影响的准确性，当地观察员分类100 VH-IVUS定义的冠状动脉斑块，以确定单中心观察员间的变异性;多中心变异性，通过与VH-IVUS核心实验室分析比较，并与灰度IVUS。使用不同的已发表的斑块定义的斑块类型的频率也被确定。单中心VH-IVUS观察者间一致性很强（kappa=0.86），但薄帽纤维动脉粥样硬化（k=0.59）较低，因为观察者对融合坏死核心的存在和位置的判断。斑块分类的多中心观察者间一致性再次降低（k=0.71），特别是薄帽纤维动脉粥样硬化（k=0.56）。不同的斑块定义进一步减少了VH-IVUS定义的薄帽纤维动脉粥样硬化的数量44%。灰阶IVUS的诊断准确性，以确定薄帽纤维动脉粥样硬化是穷人的观察者（21%和29%正确），与低观察者间的协议（k=0.14）。结论VH-IVUS斑块分类，特别是VH-IVUS定义的薄帽纤维动脉粥样硬化的识别，不同的地方观察者之间的显着差异，特别是与核心实验室分析。VH-IVUS斑块定义的差异导致了研究之间的进一步变异性。这些因素减少了VH-IVUS斑块分类在“现场”临床环境中指导干预的使用，并且还影响研究之间诊断准确性和斑块自然史的比较。(Circ血管造影。2012;5：86-93.）
Background-Recent studies show that virtual histology intravascular ultrasound (VH-IVUS) can identify plaques at high risk of rupture, such as thin-capped fibroatheromata, raising the possibility of immediate targeted intervention. However, plaque classification entails border recognition and subjective assessment of plaque architecture, introducing inter-observer variability without confirmation by core-labs. Furthermore, the accuracy of local versus core-laboratory VH-IVUS plaque classification and effects of different plaque definitions have not been examined.Methods and Results-Local observers classified 100 VH-IVUS-defined coronary plaques to determine single center inter-observer variability; multi-center variability was determined by comparison with VH-IVUS core-laboratory analysis, and compared with gray-scale IVUS. Frequency of plaque types using different published plaque definitions also was determined. Single-center VH-IVUS inter-observer agreement was strong (kappa=0.86), but lower for thin-capped fibroatheromatas (k=0.59) because of observer judgments on presence and location of confluent necrotic core. Multi-center inter-observer agreement for plaque classification was lower again (k=0.71), particularly for thin-capped fibroatheromatas (k=0.56). Different plaque definitions further reduced VH-IVUS-defined thin-capped fibroatheromata numbers by 44%. The diagnostic accuracy of gray-scale IVUS to identify thin-capped fibroatheromata was poor for both observers (21 and 29% correct), with low inter-observer agreement (k=0.14).Conclusions-VH-IVUS plaque classification, and particularly VH-IVUS-defined thin-capped fibroatheromata identification, varies significantly between local observers, and particularly in comparison with core-laboratory analysis. Differences in VH-IVUS plaque definitions introduce further variability between studies. These factors reduce the use of VH-IVUS plaque classification to guide intervention in a "live" clinical setting, and also affect comparison of diagnostic accuracy and natural history of plaques between studies. (Circ Cardiovasc Imaging. 2012;5:86-93.)