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目的确定放射学报告在描述临床上明显的颈动脉狭窄时是否采用可供临床医师参考的一致的标准。材料与方法本研究符合HIPAA。免除知情同意。本回顾性图表分析经机构审查委员会批准,包括2006—2007年间退伍军人医疗中心的127例缺血性中风的住院病人的颈动脉成像的放射学报告。临床显著结果是指狭窄至少50%或者至少中度狭窄,不包括完全闭塞。评估临床显著结果报告为确切狭窄分数(例如,60%),范围(例如,50%～69%)或分级(例如,中度)的频率。评估当结果报告为一个范围时,该范围被界定为50%和70%的临床阈值的频率(通常用于确定合适的颈动脉血运重建)。结果在2675例病人的6618个颈动脉成像结果中,1015个(15%)结果被认为具有显著临床意义。超声显示的695个临床显著结果中,348个(50%)被描述为一个范围,另外314个(45%)报告为一个确切的狭窄百分数。在348个报告为一个范围的具有显著临床意义的超声结果中,259个(74%)结果阈值被界定为50%～70%。对于MR血管成像,48%(106/221)的临床显著结果定性描述为一个分级,38%(84/221)描述为确切的狭窄百分数,14%(31/221)描述为一个范围。结论对于临床显著的颈动脉狭窄的报告方式在国家医疗服务系统中存在巨大差别。
Purpose To determine if a radiology report describes consistent clinically significant criteria for carotid artery stenosis that is available to clinicians. Materials and Methods This study is in accordance with HIPAA. Exemption from informed consent. This retrospective chart analyzes radiographic reports of carotid imaging of 127 patients with ischemic stroke admitted to the Veterans Affairs Medical Center during 2006-2007 approved by the Institutional Review Board. Clinically significant results in a stenosis of at least 50% or at least moderate stenosis, excluding complete occlusion. Assessment clinically significant results are reported as the exact stenosis score (eg, 60%), range (eg, 50% -69%), or graded (eg, moderate) frequency. Assessment When the results are reported as a range, the range is defined as the frequency of clinical thresholds of 50% and 70% (usually used to determine appropriate carotid revascularization). Results Of the 6,618 carotid artery imaging findings from 2675 patients, 1015 (15%) were considered clinically significant. Of the 695 clinically significant results shown by ultrasound, 348 (50%) were described as one range and 314 (45%) were reported as an exact percentage of stenosis. Out of 348 clinically significant ultrasound results reported as a range, 259 (74%) of the outcome thresholds were defined as 50% to 70%. For MR angiography, clinically significant results for 48% (106/221) were qualitatively described as one grade, 38% (84/221) as the exact percentage of stenosis and 14% (31/221) as a range. Conclusion There are huge differences in the way of reporting clinically significant carotid stenosis in the national healthcare service.