Diagnostic performance of an expert system for interpretation of 99mTc MAG3 scans in suspected renal obstruction
Diagnostic performance of an expert system for interpretation of 99mTc MAG3 scans in suspected renal obstruction
复制标题
DOI：
10.2967/jnumed.107.045484
复制
发表时间：
2008-02-01
影响因子：
9.3
通讯作者：
Dubovsky, Eva
中科院分区：
文献类型：
--
作者：
Taylor, Andrew;Garcia, Ernest V.;Dubovsky, Eva
本研究的目的是比较肾脏专家系统生成的利尿肾图扫描解释与3位专家阅片师的共识解释。研究方法：在95例随机选择的疑似梗阻患者（185个肾脏）中评价了专家系统;其中男性55例，女性40例，平均年龄± SD为58.6 ± 16.5岁。每例受试者均接受了基线Tc-99 m-mercaptoacetyltriglycine（Tc-99 m-MAG 3）扫描，随后给予呋塞米并单独采集20分钟。从基线和呋塞米采集中自动提取定量参数，并转发到专家系统进行分析。三位不了解临床信息的专家将每个肾脏独立分级为梗阻/可能梗阻、可疑和可能无梗阻/无梗阻;专家通过共识阅读解决差异。这3个专家类别进行了比较，有障碍的，模棱两可的，和nonobstructed的解释专家系统提供的。协议进行了评估，使用加权K，和专家系统的预测准确性相比，专家读者进行了评估的受试者工作特征（ROC曲线）曲线下面积。结果如下：专家系统在84%（101/120）的非梗阻肾、92%（33/36）的梗阻肾和45%（13/29）的可疑肾中同意共识阅读。专家系统和共识阅读之间的加权K为0.72，与专家之间的加权K相当。当专家系统与每个专家以另外2名专家为金标准进行比较时，ROC曲线下面积没有显著差异。结论：肾脏专家系统与专家的解释表现出良好的一致性，并可能是一个有用的教育和决策支持工具，以帮助医生在诊断肾梗阻。为了更好地反映临床环境，必须设计、实施和测试用于合并临床数据的算法。
The purpose of the study was to compare diuresis renography scan interpretation generated by a renal expert system with the consensus interpretation of 3 expert readers. Methods: The expert system was evaluated in 95 randomly selected furosemideaugmented patient studies (185 kidneys) obtained for suspected obstruction; there were 55 males and 40 females with a mean age +/- SD of 58.6 +/- 16.5 y. Each subject had a baseline Tc-99m-mercaptoacetyltriglycine (Tc-99m-MAG3) scan followed by furosemide administration and a separate 20-min acquisition. Quantitative parameters were automatically extracted from baseline and furosemide acquisitions and forwarded to the expert system for analysis. Three experts, unaware of clinical information, independently graded each kidney as obstructed/probably obstructed, equivocal, and probably nonobstructed/nonobstructed; experts resolved differences by a consensus reading. These 3 expert categories were compared with the obstructed, equivocal, and nonobstructed interpretations provided by the expert system. Agreement was assessed using weighted K, and the predictive accuracy of the expert system compared with expert readers was assessed by the area under receiver-operating-characteristic (ROC curve) curves. Results: The expert system agreed with the consensus reading in 84% (101/120) of nonobstructed kidneys, in 92% (33/36) of obstructed kidneys, and in 45% (13/29) of equivocal kidneys. The weighted K between the expert system and the consensus reading was 0.72 and was comparable with the weighted K between experts. There was no significant difference in the areas under the ROC curves when the expert system was compared with each expert using the other 2 experts as the gold standard. Conclusion: The renal expert system showed good agreement with the expert interpretation and could be a useful educational and decision support tool to assist physicians in the diagnosis of renal obstruction. To better mirror the clinical setting, algorithms to incorporate clinical data must be designed, implemented, and tested.