Poor inter-observer agreement in anatomical classifications of infrapopliteal arterial disease due to mandatory selection of only one target artery
(2023) In Acta radiologica (Stockholm, Sweden : 1987) 64(3). p.1298-1306- Abstract
BACKGROUND: Established anatomical classifications of infrapopliteal arterial lesion severity are based on assessment of only one target artery, not including all infrapopliteal arteries although multivessel revascularization is common.
PURPOSE: To investigate the reproducibility of one of these classifications and a new aggregated score.
MATERIAL AND METHODS: A total of 68 patients undergoing endovascular infrapopliteal revascularization at Sahlgrenska University Hospital during 2008-2016 were included. Preoperative magnetic resonance angiographies (MRA) and digital subtraction angiographies (DSA) were evaluated by three blinded observers in random order, using the infrapopliteal TransAtlantic Inter-Society Consensus (TASC)... (More)
BACKGROUND: Established anatomical classifications of infrapopliteal arterial lesion severity are based on assessment of only one target artery, not including all infrapopliteal arteries although multivessel revascularization is common.
PURPOSE: To investigate the reproducibility of one of these classifications and a new aggregated score.
MATERIAL AND METHODS: A total of 68 patients undergoing endovascular infrapopliteal revascularization at Sahlgrenska University Hospital during 2008-2016 were included. Preoperative magnetic resonance angiographies (MRA) and digital subtraction angiographies (DSA) were evaluated by three blinded observers in random order, using the infrapopliteal TransAtlantic Inter-Society Consensus (TASC) II classification. An aggregated score, the Infrapopliteal Total Atherosclerotic Burden (I-TAB) score, including all infrapopliteal arteries, was constructed and used for comparison.
RESULTS: Inter-observer agreement on lesion severity for each evaluated artery was good; Krippendorff's α for MRA 0.64-0.79 and DSA 0.66-0.84. Inter-observer agreement on TASC II grade, based on the selected target artery as stipulated, was poor; Krippendorff's α 0.14 (95% confidence interval [CI]=-0.05 to 0.30) for MRA and 0.48 (95% CI=0.33-0.61) for DSA. Inter-observer agreement for the new I-TAB score was good; Krippendorff's α 0.76 (95% CI=0.70-0.81) for MRA and 0.79 (95% CI=0.74-0.84) for DSA.
CONCLUSION: Reproducible assessment of infrapopliteal lesion severity can be achieved for separate arteries with both MRA and DSA using the TASC II definitions. However, poor inter-observer agreement in selecting the target artery results in low reproducibility of the overall infrapopliteal TASC II grade. An aggregated score, such as I-TAB, results in less variability and may provide a more robust evaluation tool of atherosclerotic disease severity.
(Less)
- author
- Ludwigs, Karin ; Andersson, Manne ; Johnsson, Åse A ; Nordanstig, Joakim ; Svalkvist, Angelica ; Falkenberg, Mårten and Baubeta, Erik LU
- organization
- publishing date
- 2023
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Acta radiologica (Stockholm, Sweden : 1987)
- volume
- 64
- issue
- 3
- pages
- 1298 - 1306
- publisher
- SAGE Publications
- external identifiers
-
- scopus:85131193932
- pmid:35619547
- ISSN
- 1600-0455
- DOI
- 10.1177/02841851221102788
- language
- English
- LU publication?
- yes
- id
- 56d8130a-88f1-4d06-af4e-b9942543bef6
- date added to LUP
- 2022-07-25 10:41:01
- date last changed
- 2024-09-16 15:59:39
@article{56d8130a-88f1-4d06-af4e-b9942543bef6, abstract = {{<p>BACKGROUND: Established anatomical classifications of infrapopliteal arterial lesion severity are based on assessment of only one target artery, not including all infrapopliteal arteries although multivessel revascularization is common.</p><p>PURPOSE: To investigate the reproducibility of one of these classifications and a new aggregated score.</p><p>MATERIAL AND METHODS: A total of 68 patients undergoing endovascular infrapopliteal revascularization at Sahlgrenska University Hospital during 2008-2016 were included. Preoperative magnetic resonance angiographies (MRA) and digital subtraction angiographies (DSA) were evaluated by three blinded observers in random order, using the infrapopliteal TransAtlantic Inter-Society Consensus (TASC) II classification. An aggregated score, the Infrapopliteal Total Atherosclerotic Burden (I-TAB) score, including all infrapopliteal arteries, was constructed and used for comparison.</p><p>RESULTS: Inter-observer agreement on lesion severity for each evaluated artery was good; Krippendorff's α for MRA 0.64-0.79 and DSA 0.66-0.84. Inter-observer agreement on TASC II grade, based on the selected target artery as stipulated, was poor; Krippendorff's α 0.14 (95% confidence interval [CI]=-0.05 to 0.30) for MRA and 0.48 (95% CI=0.33-0.61) for DSA. Inter-observer agreement for the new I-TAB score was good; Krippendorff's α 0.76 (95% CI=0.70-0.81) for MRA and 0.79 (95% CI=0.74-0.84) for DSA.</p><p>CONCLUSION: Reproducible assessment of infrapopliteal lesion severity can be achieved for separate arteries with both MRA and DSA using the TASC II definitions. However, poor inter-observer agreement in selecting the target artery results in low reproducibility of the overall infrapopliteal TASC II grade. An aggregated score, such as I-TAB, results in less variability and may provide a more robust evaluation tool of atherosclerotic disease severity.</p>}}, author = {{Ludwigs, Karin and Andersson, Manne and Johnsson, Åse A and Nordanstig, Joakim and Svalkvist, Angelica and Falkenberg, Mårten and Baubeta, Erik}}, issn = {{1600-0455}}, language = {{eng}}, number = {{3}}, pages = {{1298--1306}}, publisher = {{SAGE Publications}}, series = {{Acta radiologica (Stockholm, Sweden : 1987)}}, title = {{Poor inter-observer agreement in anatomical classifications of infrapopliteal arterial disease due to mandatory selection of only one target artery}}, url = {{http://dx.doi.org/10.1177/02841851221102788}}, doi = {{10.1177/02841851221102788}}, volume = {{64}}, year = {{2023}}, }