Inter-observer variability in the angiographic assessment of renal artery stenosis: DRASTIC study group. Dutch Renal Artery Stenosis Intervention Coorperative

Brigit C. Van Jaarsveld, Herman Pieterman, Lucas C. Van Dijk, Andries J. Van Seijen, Pieta Krijnen, Frans H.M. Derkx, Arie J. Man In't Veld, Maarten A.D.H. Schalekamp

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Objective. To assess inter-observer agreement in the interpretation of renal angiograms. Design. Comparison of the assessment of renal angiograms by three experienced radiologists, who evaluated the number of renal arteries and the presence, location, aspect and severity of a renal artery stenosis. Setting. General hospital and university hospital serving urban and rural populations. Patients. Patients with difficult-to-treat hypertension referred for diagnostic work-up; 312 angiograms with the intra-arterial digital subtraction technique were obtained from 289 consecutive patients. Main outcome measures. Inter-observer agreement was tested for the following parameters: number of arteries per kidney, presence of stenosis, location of stenosis (truncal, ostial), aspect of stenosis (concentric, eccentric, post-stenotic dilatation), severity of stenosis (reduction of lumen diameter in categories of 30%, 40%, etc. to 100%), and overall quality of the angiographic images. Kappa (κ) values and weighted κ between the three pairs of radiologists were used as estimates of inter-observer agreement. Results. Agreement about the number of renal arteries was reasonable (κ = 0.50-0.72), as was agreement about the presence of stenosis (κ = 0.68-0.86). Agreement about stenosis location and aspect was poor (κ = 0.26-0.47 and κ = 0.15-0.26, respectively). There was general agreement about the severity of stenosis (weighted κ = 0.65-0.70), but it was not possible to distinguish between 50 and 60% stenosis or between 60 and 70% stenosis (κ < 0.40). No correlation was found between agreement on severity of stenosis and the quality of the images. Conclusions. It is not realistic to make statements about what degree of renal artery stenosis is clinically significant, as long as the intra-arterial angiogram with digital subtraction remains the gold standard. It is likewise risky to rely too strongly on stenosis morphology as visualized by renal angiography in choosing between balloon angioplasty and stent deployment.

Original languageEnglish
Pages (from-to)1731-1736
Number of pages6
JournalJournal of Hypertension
Volume17
Issue number12
DOIs
Publication statusPublished - 22 Dec 1999

Cite this

Van Jaarsveld, Brigit C. ; Pieterman, Herman ; Van Dijk, Lucas C. ; Van Seijen, Andries J. ; Krijnen, Pieta ; Derkx, Frans H.M. ; Man In't Veld, Arie J. ; Schalekamp, Maarten A.D.H. / Inter-observer variability in the angiographic assessment of renal artery stenosis : DRASTIC study group. Dutch Renal Artery Stenosis Intervention Coorperative. In: Journal of Hypertension. 1999 ; Vol. 17, No. 12. pp. 1731-1736.
@article{7d98cb5b8eb84ed0acc5e1b426a6ed8f,
title = "Inter-observer variability in the angiographic assessment of renal artery stenosis: DRASTIC study group. Dutch Renal Artery Stenosis Intervention Coorperative",
abstract = "Objective. To assess inter-observer agreement in the interpretation of renal angiograms. Design. Comparison of the assessment of renal angiograms by three experienced radiologists, who evaluated the number of renal arteries and the presence, location, aspect and severity of a renal artery stenosis. Setting. General hospital and university hospital serving urban and rural populations. Patients. Patients with difficult-to-treat hypertension referred for diagnostic work-up; 312 angiograms with the intra-arterial digital subtraction technique were obtained from 289 consecutive patients. Main outcome measures. Inter-observer agreement was tested for the following parameters: number of arteries per kidney, presence of stenosis, location of stenosis (truncal, ostial), aspect of stenosis (concentric, eccentric, post-stenotic dilatation), severity of stenosis (reduction of lumen diameter in categories of 30{\%}, 40{\%}, etc. to 100{\%}), and overall quality of the angiographic images. Kappa (κ) values and weighted κ between the three pairs of radiologists were used as estimates of inter-observer agreement. Results. Agreement about the number of renal arteries was reasonable (κ = 0.50-0.72), as was agreement about the presence of stenosis (κ = 0.68-0.86). Agreement about stenosis location and aspect was poor (κ = 0.26-0.47 and κ = 0.15-0.26, respectively). There was general agreement about the severity of stenosis (weighted κ = 0.65-0.70), but it was not possible to distinguish between 50 and 60{\%} stenosis or between 60 and 70{\%} stenosis (κ < 0.40). No correlation was found between agreement on severity of stenosis and the quality of the images. Conclusions. It is not realistic to make statements about what degree of renal artery stenosis is clinically significant, as long as the intra-arterial angiogram with digital subtraction remains the gold standard. It is likewise risky to rely too strongly on stenosis morphology as visualized by renal angiography in choosing between balloon angioplasty and stent deployment.",
keywords = "Angiography, Inter-observer agreement, Renal artery stenosis",
author = "{Van Jaarsveld}, {Brigit C.} and Herman Pieterman and {Van Dijk}, {Lucas C.} and {Van Seijen}, {Andries J.} and Pieta Krijnen and Derkx, {Frans H.M.} and {Man In't Veld}, {Arie J.} and Schalekamp, {Maarten A.D.H.}",
year = "1999",
month = "12",
day = "22",
doi = "10.1097/00004872-199917120-00010",
language = "English",
volume = "17",
pages = "1731--1736",
journal = "Journal of Hypertension",
issn = "0263-6352",
publisher = "Lippincott Williams and Wilkins",
number = "12",

}

Inter-observer variability in the angiographic assessment of renal artery stenosis : DRASTIC study group. Dutch Renal Artery Stenosis Intervention Coorperative. / Van Jaarsveld, Brigit C.; Pieterman, Herman; Van Dijk, Lucas C.; Van Seijen, Andries J.; Krijnen, Pieta; Derkx, Frans H.M.; Man In't Veld, Arie J.; Schalekamp, Maarten A.D.H.

In: Journal of Hypertension, Vol. 17, No. 12, 22.12.1999, p. 1731-1736.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Inter-observer variability in the angiographic assessment of renal artery stenosis

T2 - DRASTIC study group. Dutch Renal Artery Stenosis Intervention Coorperative

AU - Van Jaarsveld, Brigit C.

AU - Pieterman, Herman

AU - Van Dijk, Lucas C.

AU - Van Seijen, Andries J.

AU - Krijnen, Pieta

AU - Derkx, Frans H.M.

AU - Man In't Veld, Arie J.

AU - Schalekamp, Maarten A.D.H.

PY - 1999/12/22

Y1 - 1999/12/22

N2 - Objective. To assess inter-observer agreement in the interpretation of renal angiograms. Design. Comparison of the assessment of renal angiograms by three experienced radiologists, who evaluated the number of renal arteries and the presence, location, aspect and severity of a renal artery stenosis. Setting. General hospital and university hospital serving urban and rural populations. Patients. Patients with difficult-to-treat hypertension referred for diagnostic work-up; 312 angiograms with the intra-arterial digital subtraction technique were obtained from 289 consecutive patients. Main outcome measures. Inter-observer agreement was tested for the following parameters: number of arteries per kidney, presence of stenosis, location of stenosis (truncal, ostial), aspect of stenosis (concentric, eccentric, post-stenotic dilatation), severity of stenosis (reduction of lumen diameter in categories of 30%, 40%, etc. to 100%), and overall quality of the angiographic images. Kappa (κ) values and weighted κ between the three pairs of radiologists were used as estimates of inter-observer agreement. Results. Agreement about the number of renal arteries was reasonable (κ = 0.50-0.72), as was agreement about the presence of stenosis (κ = 0.68-0.86). Agreement about stenosis location and aspect was poor (κ = 0.26-0.47 and κ = 0.15-0.26, respectively). There was general agreement about the severity of stenosis (weighted κ = 0.65-0.70), but it was not possible to distinguish between 50 and 60% stenosis or between 60 and 70% stenosis (κ < 0.40). No correlation was found between agreement on severity of stenosis and the quality of the images. Conclusions. It is not realistic to make statements about what degree of renal artery stenosis is clinically significant, as long as the intra-arterial angiogram with digital subtraction remains the gold standard. It is likewise risky to rely too strongly on stenosis morphology as visualized by renal angiography in choosing between balloon angioplasty and stent deployment.

AB - Objective. To assess inter-observer agreement in the interpretation of renal angiograms. Design. Comparison of the assessment of renal angiograms by three experienced radiologists, who evaluated the number of renal arteries and the presence, location, aspect and severity of a renal artery stenosis. Setting. General hospital and university hospital serving urban and rural populations. Patients. Patients with difficult-to-treat hypertension referred for diagnostic work-up; 312 angiograms with the intra-arterial digital subtraction technique were obtained from 289 consecutive patients. Main outcome measures. Inter-observer agreement was tested for the following parameters: number of arteries per kidney, presence of stenosis, location of stenosis (truncal, ostial), aspect of stenosis (concentric, eccentric, post-stenotic dilatation), severity of stenosis (reduction of lumen diameter in categories of 30%, 40%, etc. to 100%), and overall quality of the angiographic images. Kappa (κ) values and weighted κ between the three pairs of radiologists were used as estimates of inter-observer agreement. Results. Agreement about the number of renal arteries was reasonable (κ = 0.50-0.72), as was agreement about the presence of stenosis (κ = 0.68-0.86). Agreement about stenosis location and aspect was poor (κ = 0.26-0.47 and κ = 0.15-0.26, respectively). There was general agreement about the severity of stenosis (weighted κ = 0.65-0.70), but it was not possible to distinguish between 50 and 60% stenosis or between 60 and 70% stenosis (κ < 0.40). No correlation was found between agreement on severity of stenosis and the quality of the images. Conclusions. It is not realistic to make statements about what degree of renal artery stenosis is clinically significant, as long as the intra-arterial angiogram with digital subtraction remains the gold standard. It is likewise risky to rely too strongly on stenosis morphology as visualized by renal angiography in choosing between balloon angioplasty and stent deployment.

KW - Angiography

KW - Inter-observer agreement

KW - Renal artery stenosis

UR - http://www.scopus.com/inward/record.url?scp=0032761682&partnerID=8YFLogxK

U2 - 10.1097/00004872-199917120-00010

DO - 10.1097/00004872-199917120-00010

M3 - Article

VL - 17

SP - 1731

EP - 1736

JO - Journal of Hypertension

JF - Journal of Hypertension

SN - 0263-6352

IS - 12

ER -