Venography of the lower limbs. Pitfalls of the diagnostic standard

H Bounameaux; T R Prins; H E Schmitt; P A Schneider; W Haarman; W Schmidt; P de Moerloose; F Mahler; B Lammle; A de Torrente; J N Fiessinger; J F Vitoux; J Ninet; J van der Meer; C Henkens; G Woolthuis; J D Banga; W P T M Mali; H W de Valk; O J A T Meuwissen; B C Eikelboom; B van Ramshorst; W P M Breed; J Buth; T J M Ruers; D Lockner; S Johansson; R Verhaeghe; J Vermylen; S Coccheri; V De Rosa; M Campos; F Losinno; R Odavic; T Danays; R Cariou; R van Tol; A Tullgren; L Visani; E Bluhmki; W Haarmann

doi:10.1097/00004424-199212000-00004

Venography of the lower limbs. Pitfalls of the diagnostic standard

H Bounameaux^*, T R Prins, H E Schmitt, P A Schneider, W Haarman, W Schmidt, P de Moerloose, F Mahler, B Lammle, A de Torrente, J N Fiessinger, J F Vitoux, J Ninet, J van der Meer, C Henkens, G Woolthuis, J D Banga, W P T M Mali, H W de Valk, O J A T MeuwissenB C Eikelboom, B van Ramshorst, W P M Breed, J Buth, T J M Ruers, D Lockner, S Johansson, R Verhaeghe, J Vermylen, S Coccheri, V De Rosa, M Campos, F Losinno, R Odavic, T Danays, R Cariou, R van Tol, A Tullgren, L Visani, E Bluhmki, W Haarmann

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

RATIONALE AND OBJECTIVES. Phlebography is considered the diagnostic standard for suspected deep venous thrombosis. The authors studied the inter-observer variability of phlebogram interpretation in the setting of a multicenter therapeutic trial of the thrombolytic agent alteplase.

METHODS. The interpretation of 31 pairs of venograms (before and after thrombolytic therapy) was studied by comparing the quantitative Marder's scores which were computed by three experts and the qualitative assessment of phlebographic changes induced by thrombolysis by the panel of experts and by the investigators.

RESULTS. Although the scores of the three experts correlated fairly well (r = .67-.82; P <.001), they differed significantly from each other (P <.0001). Substantial differences also were found between local (by investigators) qualitative evaluation of the venographic changes induced by the treatment and central evaluation by the panel of experts (coefficient of agreement kappa = 0.19), local assessment being significantly more optimistic (P = .002) than central judgment.

CONCLUSION. Significant differences were observed between assessment of changes in venographic scores after thrombolytic treatment both among three expert radiologists, and between the panel of experts and the local investigators of the multicenter trial. This observation points to the need for an a priori definition of well-characterized decision criteria to allow a valid interpretation of the effects of the therapeutic intervention.

Original language	English
Pages (from-to)	1009-1011
Number of pages	3
Journal	Investigative Radiology
Volume	27
Issue number	12
DOIs	https://doi.org/10.1097/00004424-199212000-00004
Publication status	Published - Dec-1992

Keywords

VENOUS THROMBOSIS

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Venography of the lower limbs. Pitfalls of the diagnostic standard
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Bounameaux, H., Prins, T. R., Schmitt, H. E., Schneider, P. A., Haarman, W., Schmidt, W., de Moerloose, P., Mahler, F., Lammle, B., de Torrente, A., Fiessinger, J. N., Vitoux, J. F., Ninet, J., van der Meer, J., Henkens, C., Woolthuis, G., Banga, J. D., Mali, W. P. T. M., de Valk, H. W., ... Haarmann, W. (1992). Venography of the lower limbs. Pitfalls of the diagnostic standard. Investigative Radiology, 27(12), 1009-1011. https://doi.org/10.1097/00004424-199212000-00004

@article{3cd300dd28034d629cf567f8fc6dc55e,

title = "Venography of the lower limbs. Pitfalls of the diagnostic standard",

abstract = "RATIONALE AND OBJECTIVES. Phlebography is considered the diagnostic standard for suspected deep venous thrombosis. The authors studied the inter-observer variability of phlebogram interpretation in the setting of a multicenter therapeutic trial of the thrombolytic agent alteplase.METHODS. The interpretation of 31 pairs of venograms (before and after thrombolytic therapy) was studied by comparing the quantitative Marder's scores which were computed by three experts and the qualitative assessment of phlebographic changes induced by thrombolysis by the panel of experts and by the investigators.RESULTS. Although the scores of the three experts correlated fairly well (r = .67-.82; P <.001), they differed significantly from each other (P <.0001). Substantial differences also were found between local (by investigators) qualitative evaluation of the venographic changes induced by the treatment and central evaluation by the panel of experts (coefficient of agreement kappa = 0.19), local assessment being significantly more optimistic (P = .002) than central judgment.CONCLUSION. Significant differences were observed between assessment of changes in venographic scores after thrombolytic treatment both among three expert radiologists, and between the panel of experts and the local investigators of the multicenter trial. This observation points to the need for an a priori definition of well-characterized decision criteria to allow a valid interpretation of the effects of the therapeutic intervention.",

keywords = "VENOUS THROMBOSIS",

author = "H Bounameaux and Prins, {T R} and Schmitt, {H E} and Schneider, {P A} and W Haarman and W Schmidt and {de Moerloose}, P and F Mahler and B Lammle and {de Torrente}, A and Fiessinger, {J N} and Vitoux, {J F} and J Ninet and {van der Meer}, J and C Henkens and G Woolthuis and Banga, {J D} and Mali, {W P T M} and {de Valk}, {H W} and Meuwissen, {O J A T} and Eikelboom, {B C} and {van Ramshorst}, B and Breed, {W P M} and J Buth and Ruers, {T J M} and D Lockner and S Johansson and R Verhaeghe and J Vermylen and S Coccheri and {De Rosa}, V and M Campos and F Losinno and R Odavic and T Danays and R Cariou and {van Tol}, R and A Tullgren and L Visani and E Bluhmki and W Haarmann",

year = "1992",

month = dec,

doi = "10.1097/00004424-199212000-00004",

language = "English",

volume = "27",

pages = "1009--1011",

journal = "Investigative Radiology",

issn = "0020-9996",

publisher = "Lippincott Williams and Wilkins",

number = "12",

}

Bounameaux, H, Prins, TR, Schmitt, HE, Schneider, PA, Haarman, W, Schmidt, W, de Moerloose, P, Mahler, F, Lammle, B, de Torrente, A, Fiessinger, JN, Vitoux, JF, Ninet, J, van der Meer, J, Henkens, C, Woolthuis, G, Banga, JD, Mali, WPTM, de Valk, HW, Meuwissen, OJAT, Eikelboom, BC, van Ramshorst, B, Breed, WPM, Buth, J, Ruers, TJM, Lockner, D, Johansson, S, Verhaeghe, R, Vermylen, J, Coccheri, S, De Rosa, V, Campos, M, Losinno, F, Odavic, R, Danays, T, Cariou, R, van Tol, R, Tullgren, A, Visani, L, Bluhmki, E & Haarmann, W 1992, 'Venography of the lower limbs. Pitfalls of the diagnostic standard', Investigative Radiology, vol. 27, no. 12, pp. 1009-1011. https://doi.org/10.1097/00004424-199212000-00004

TY - JOUR

T1 - Venography of the lower limbs. Pitfalls of the diagnostic standard

AU - Bounameaux, H

AU - Prins, T R

AU - Schmitt, H E

AU - Schneider, P A

AU - Haarman, W

AU - Schmidt, W

AU - de Moerloose, P

AU - Mahler, F

AU - Lammle, B

AU - de Torrente, A

AU - Fiessinger, J N

AU - Vitoux, J F

AU - Ninet, J

AU - van der Meer, J

AU - Henkens, C

AU - Woolthuis, G

AU - Banga, J D

AU - Mali, W P T M

AU - de Valk, H W

AU - Meuwissen, O J A T

AU - Eikelboom, B C

AU - van Ramshorst, B

AU - Breed, W P M

AU - Buth, J

AU - Ruers, T J M

AU - Lockner, D

AU - Johansson, S

AU - Verhaeghe, R

AU - Vermylen, J

AU - Coccheri, S

AU - De Rosa, V

AU - Campos, M

AU - Losinno, F

AU - Odavic, R

AU - Danays, T

AU - Cariou, R

AU - van Tol, R

AU - Tullgren, A

AU - Visani, L

AU - Bluhmki, E

AU - Haarmann, W

PY - 1992/12

Y1 - 1992/12

N2 - RATIONALE AND OBJECTIVES. Phlebography is considered the diagnostic standard for suspected deep venous thrombosis. The authors studied the inter-observer variability of phlebogram interpretation in the setting of a multicenter therapeutic trial of the thrombolytic agent alteplase.METHODS. The interpretation of 31 pairs of venograms (before and after thrombolytic therapy) was studied by comparing the quantitative Marder's scores which were computed by three experts and the qualitative assessment of phlebographic changes induced by thrombolysis by the panel of experts and by the investigators.RESULTS. Although the scores of the three experts correlated fairly well (r = .67-.82; P <.001), they differed significantly from each other (P <.0001). Substantial differences also were found between local (by investigators) qualitative evaluation of the venographic changes induced by the treatment and central evaluation by the panel of experts (coefficient of agreement kappa = 0.19), local assessment being significantly more optimistic (P = .002) than central judgment.CONCLUSION. Significant differences were observed between assessment of changes in venographic scores after thrombolytic treatment both among three expert radiologists, and between the panel of experts and the local investigators of the multicenter trial. This observation points to the need for an a priori definition of well-characterized decision criteria to allow a valid interpretation of the effects of the therapeutic intervention.

AB - RATIONALE AND OBJECTIVES. Phlebography is considered the diagnostic standard for suspected deep venous thrombosis. The authors studied the inter-observer variability of phlebogram interpretation in the setting of a multicenter therapeutic trial of the thrombolytic agent alteplase.METHODS. The interpretation of 31 pairs of venograms (before and after thrombolytic therapy) was studied by comparing the quantitative Marder's scores which were computed by three experts and the qualitative assessment of phlebographic changes induced by thrombolysis by the panel of experts and by the investigators.RESULTS. Although the scores of the three experts correlated fairly well (r = .67-.82; P <.001), they differed significantly from each other (P <.0001). Substantial differences also were found between local (by investigators) qualitative evaluation of the venographic changes induced by the treatment and central evaluation by the panel of experts (coefficient of agreement kappa = 0.19), local assessment being significantly more optimistic (P = .002) than central judgment.CONCLUSION. Significant differences were observed between assessment of changes in venographic scores after thrombolytic treatment both among three expert radiologists, and between the panel of experts and the local investigators of the multicenter trial. This observation points to the need for an a priori definition of well-characterized decision criteria to allow a valid interpretation of the effects of the therapeutic intervention.

KW - VENOUS THROMBOSIS

U2 - 10.1097/00004424-199212000-00004

DO - 10.1097/00004424-199212000-00004

M3 - Article

SN - 0020-9996

VL - 27

SP - 1009

EP - 1011

JO - Investigative Radiology

JF - Investigative Radiology

IS - 12

ER -

Venography of the lower limbs. Pitfalls of the diagnostic standard

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