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Interobserver agreement of the TASC II classification for supra- and infrainguinal lesions
A Zimmermann1, H Wendorff, T Schuster
1Clinic of Vascular Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str 22, 81675 München, Germany.
Insights
Interobserver agreement for TASC II classification in peripheral arterial occlusive disease (PAOD) using magnetic resonance angiography (MRA) was assessed. Consultants showed higher agreement than residents, and surgeons agreed more than radiologists, particularly for femoro-popliteal lesions.
Area of Science:
- Vascular Surgery
- Radiology
- Medical Imaging
Background:
- The Trans-Atlantic Inter-Society Document (TASC) provides treatment guidelines for peripheral arterial disease (PAD) based on lesion classification.
- Accurate TASC classification is crucial for optimal patient management.
- Magnetic Resonance Angiography (MRA) is a key imaging modality for evaluating PAD.
Purpose of the Study:
- To evaluate the interobserver agreement of the TASC II classification for peripheral arterial occlusive disease (PAOD) using MRA.
- To compare agreement levels between different levels of expertise (residents vs. consultants) and specialties (radiology vs. vascular surgery).
Main Methods:
- Three hundred arterial segments from 149 patients with PAOD evaluated via MRA.
- Independent grading of TASC II classification by a radiology resident, a radiology consultant, and a vascular surgery consultant.
- Statistical analysis using generalized estimation equation models and weighted kappa coefficient (kappa) to quantify agreement.
Main Results:
- Overall interobserver agreement for TASC II classification was good to excellent among consultants.
- Consultants demonstrated significantly higher agreement than residents (Odds Ratio [OR]: 2.86).
- Surgeons showed significantly higher agreement than radiologists (OR: 1.43), and agreement was better for femoro-popliteal regions than aorto-iliac regions (OR: 1.64).
Conclusions:
- While TASC II classification shows good agreement among experienced clinicians, particularly consultants, its complexity may limit daily clinical utility.
- Simplifying the TASC II classification could enhance its practicality and consistency in routine clinical practice for PAOD management.
Objectives:
The Trans-Atlantic Inter-Society Document on Management of Peripheral Arterial Disease (TASC) gives treatment recommendations depending on the classification of aorto-iliacal or femoro-popliteal vascular pathologies. Therefore, the best treatment could only be offered if the right TASC classification was obtained. The purpose of this study was to assess the interobserver agreement of the evaluation of the TASC II classification for peripheral arterial occlusive disease (PAOD) in magnetic resonance angiography (MRA).
Patients And Methods:
Three hundred arterial segments of 149 patients with a magnetic MRA for PAOD were evaluated according to the TASC II classification. A resident and a consultant for radiology and vascular surgery both performed independent grading. A comparative assessment of the consensus agreement was quantified by the marginal probabilities calculated by generalised estimation equation models, as well as by using the weighted kappa coefficient (kappa), classified according to Altman.
Results:
In relation to the consensus, the overall agreement was good to excellent for the consultants of radiology and vascular surgery. The consultants obtained a statistically significant higher agreement than did the residents (Odds ratio (OR): 2.86, 95% confidence interval (CI): 2.21-3.69, p<0.001). A significantly higher consensus agreement probability was observed for the surgeons compared with the radiologists (OR: 1.43, 95% CI: 1.11-1.84, p=0.006) and for the femoro-popliteal regions compared with the aorto-iliacal regions (OR: 1.64, 95% CI: 1.12-2.14, p=0.012).
Conclusion:
Although good results can be achieved in the assessment of vascular lesions according to the TASC II document, a simplification of this classification could increase its practicability in a daily clinical routine.
