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Interobserver variability in the interpretation of renal digital subtraction angiography
J F Paul1, I Cherrak, M C Jaulent
1Cardio-Vascular Radiology, Broussais University Hospital, Paris, France.
Objective:
Our purpose was to analyze interobserver variability in the interpretation of renal digital subtraction angiography and to describe the main factors associated with observer discrepancies.
Materials And Methods:
Forty-nine cases of unilateral atheromatous renal artery stenosis of more than 60% were quantified first by local investigators in a multicenter study and then by five other radiologists. Differences between radiologists for the minimum diameter (Dmin), the reference diameter (Dref), and the percentage of stenosis of the renal arteries were analyzed. Interpretations by the local investigators were then compared with the gold standard, defined as the mean for the five radiologists.
Results:
The average SD for estimation of all renal artery stenoses by all radiologists was 7% for stenosis percentage, 0.5 mm for Dmin, and 0.7 mm for Dref. Main discrepancies occurred more frequently in cases of weakly opacified renal artery stenosis and poststenotic dilatation. The observations of local investigators disagreed by more than two SDs (14%) with the gold standard for 11 of 49 cases (22%).
Conclusion:
The accuracy of digital subtraction angiography in renal artery interpretations is poor because of variations in evaluating both Dmin and Dref. Precise and reproducible methods for quantification of renal artery stenosis are required.