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González-Campo L, Vicente-Bártulos A, Gaetano-Gil A, Estelles-Lerga P, Pecharromán-de Las Heras I, Zamora J. Coronary computed tomography in emergencies: The importance of the radiologist's experience. Radiologia (Engl Ed) 2023; 65:298-306. [PMID: 37516483 DOI: 10.1016/j.rxeng.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/19/2021] [Indexed: 07/31/2023]
Abstract
INTRODUCTION Incorporating coronary computed tomography angiography (CTA) in the hospital workup for suspected acute coronary syndrome requires appropriate skills for interpreting this imaging test. Radiologists' skills can affect the interobserver agreement in evaluating these studies. OBJECTIVE To determine the interobserver agreement according to radiologists' experience in the interpretation of coronary CTA studies done in patients who present at the emergency department with acute chest pain and low-to-intermediate probability of acute coronary syndrome. MATERIALS AND METHODS We studied the interobserver agreement in the urgent evaluation of coronary CTA studies in which CAD-RADS was used to register the findings. We created pairs of observers among a total of 8 assessors (4 attending radiologists and 4 radiology residents). We used the kappa coefficient to estimate the overall concordance and the concordance between subgroups according to their experience. RESULTS The agreement was substantial between experienced radiologists and residents (k=0.627; 95%CI: 0.436-0.826) as well as between all the pairs of observers (k=0.661; 95%CI: 0.506-0.823) for all the CAD-RADS together. The degree of agreement within the group of experienced radiologists was greater than that within the group of residents in all the analyses. The agreement was excellent for the overall CAD-RADS (k=0.950; 95% CI: 0.896-1) and for CAD-RADS ≥ 4 (k=1); the agreement was lower for CAD-RADS ≥ 3 (k=0.754; 95% CI: 0.246-1.255). The agreement for the residents for these categories was k=0.623, k=0.596, and k=0.473, respectively. CONCLUSION The agreement among attending radiologists regarding the assessment of urgent coronary CTA studies is excellent. The agreement is lower when residents are paired with attending radiologists. These findings should be taken into consideration when implementing coronary CTA in emergency departments and in the organisation of radiological staff for interpreting and reporting this imaging test.
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Affiliation(s)
- L González-Campo
- Servicio de Radiodiagnóstico, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | - A Vicente-Bártulos
- Servicio de Radiodiagnóstico, Hospital Universitario Ramón y Cajal, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - A Gaetano-Gil
- Unidad de Bioestadística Clínica, Hospital Ramón y Cajal (IRYCIS), Madrid, Spain
| | | | | | - J Zamora
- Unidad de Bioestadística Clínica, Hospital Ramón y Cajal (IRYCIS), Madrid, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain; Institute of Applied Research, University of Birmingham, United Kingdom
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Mocci E, Guillen-Ponce C, Earl J, Marquez M, Solera J, Salazar-López MT, Calcedo-Arnáiz C, Vázquez-Sequeiros E, Montans J, Muñoz-Beltrán M, Vicente-Bártulos A, González-Gordaliza C, Sanjuanbenito A, Guerrero C, Mendía E, Lisa E, Lobo E, Martínez JC, Real FX, Malats N, Carrato A. PanGen-Fam: Spanish registry of hereditary pancreatic cancer. Eur J Cancer 2015. [PMID: 26212471 DOI: 10.1016/j.ejca.2015.07.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To describe the organisation of the registry and the preliminary results in terms of characteristics of high-risk pancreatic ductal adenocarcinoma (PDAC) families recruited to date and findings of the screening programme. To compare early onset sporadic cases (⩽50 years), sporadic cases (>50 years) and cases with family history of cancer, for PDAC possible risk factors. METHODS/PATIENTS Families with hereditary cancer syndromes predisposing to PDAC were recruited from two main sources: Spanish hospitals participating in PanGenEU, a pan-European multicentre case-control study, and their genetic counseling unit. Individuals at high-risk of PDAC were enrolled into a screening programme, consisting of Endoscopic ultrasound, computerised tomography, magnetic resonance imaging. Genetic testing of candidate genes was offered according to each patient's risk. RESULTS Among 577 consecutive PDAC cases, recruited via PanGenEU, 36 (6%) had ⩾2 first-degree relative with PDAC: Familial pancreatic cancer (FPC). So far PanGen-Fam has recruited 42 high-risk PDAC families; 25 (60%) had FPC. Five index cases with cancer were positive for BRCA2 and one for BRCA1 germline mutations. In the second year of prospective PDAC screening, one neuroendocrine tumour and a high-grade dysplasia lesion suspicious of carcinoma were diagnosed among 41 high-risk individuals. Furthermore EUS detected chronic-pancreatitis-like parenchymal changes in 15 patients. CONCLUDING STATEMENT The identification and recruitment of PDAC high-risk families into the PanGen-Fam registry provides an opportunity to detect early onset cancer and precursor pancreatic cancer lesions at a potentially curative stage and to increase the knowledge of the natural history of the disease.
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Affiliation(s)
- E Mocci
- Medical Oncology Department, Ramon y Cajal University Hospital, IRYCIS, Madrid, Spain
| | - C Guillen-Ponce
- Medical Oncology Department, Ramon y Cajal University Hospital, IRYCIS, Madrid, Spain
| | - J Earl
- Medical Oncology Department, Ramon y Cajal University Hospital, IRYCIS, Madrid, Spain
| | - M Marquez
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - J Solera
- Molecular Oncogenetics Unit, Institute of Medical and Molecular Genetics, La Paz Hospital, Madrid, Spain
| | - M-T Salazar-López
- Medical Oncology Department, Ramon y Cajal University Hospital, IRYCIS, Madrid, Spain
| | - C Calcedo-Arnáiz
- Medical Oncology Department, Ramon y Cajal University Hospital, IRYCIS, Madrid, Spain
| | - E Vázquez-Sequeiros
- Digestive Department, Ramon y Cajal University Hospital, IRYCIS, Madrid, Spain
| | - J Montans
- Pathology Department, Ramon y Cajal University Hospital, IRYCIS, Madrid, Spain
| | - M Muñoz-Beltrán
- Radiology Department, Ramon y Cajal University Hospital, IRYCIS, Madrid, Spain
| | - A Vicente-Bártulos
- Radiology Department, Ramon y Cajal University Hospital, IRYCIS, Madrid, Spain
| | | | - A Sanjuanbenito
- Surgery Department, Ramon y Cajal University Hospital, IRYCIS, Madrid, Spain
| | - C Guerrero
- Medical Oncology Department, Ramon y Cajal University Hospital, IRYCIS, Madrid, Spain
| | - E Mendía
- Surgery Department, Ramon y Cajal University Hospital, IRYCIS, Madrid, Spain
| | - E Lisa
- Surgery Department, Ramon y Cajal University Hospital, IRYCIS, Madrid, Spain
| | - E Lobo
- Surgery Department, Ramon y Cajal University Hospital, IRYCIS, Madrid, Spain
| | - J C Martínez
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - F X Real
- Epithelial Carcinogenesis Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain; Department de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain
| | - N Malats
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - A Carrato
- Medical Oncology Department, Ramon y Cajal University Hospital, IRYCIS, Madrid, Spain
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García-Blázquez V, Vicente-Bártulos A, Olavarria-Delgado A, Plana MN, van der Winden D, Zamora J. Accuracy of CT angiography in the diagnosis of acute gastrointestinal bleeding: systematic review and meta-analysis. Eur Radiol 2012. [PMID: 23192375 DOI: 10.1007/s00330-012-2721-x] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To assess the diagnostic accuracy of computed tomography (CT) angiography in the evaluation of patients with an episode of acute gastrointestinal haemorrhage. METHODS Systematic review and meta-analysis to estimate pooled accuracy indices. A bivariate random effects model was adjusted to obtain a summary receiver-operating characteristic (sROC) curve and the corresponding area under the curve (AUC). RESULTS Twenty-two studies were included and provided data on 672 patients (range of age 5-74) with a mean age of 65 years. The overall sensitivity of CT angiography for detecting active acute GI haemorrhage was 85.2 % (95 % CI 75.5 % to 91.5 %). The overall specificity of CT angiography was 92.1 % (95 % CI 76.7 % to 97.7 %). The likelihood ratios for positive and negative test results were 10.8 (95 % CI 3.4 to 34.4) and 0.16 (95 % CI 0.1 to 0.27) respectively, with an AUC of 0.935 (95 % CI 0.693 to 0.989). The sources of heterogeneity explored had no significant impact on diagnostic performance. CONCLUSIONS CT shows high diagnostic accuracy and is an excellent diagnostic tool for detection and localising of intestinal bleeding sites. It is highly available, provides fast detection and localisation of the bleeding site, and is minimally invasive. KEY POINTS • CT angiography is increasingly used for investigating severe gastrointestinal bleeding. • This systematic review and meta-analysis updates previous ones. • In patients with massive gastrointestinal bleeding, CT angiography/MDCT detects bleeding accurately. • CT angiography is useful in locating the bleeding site and determining appropriate treatment.
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Affiliation(s)
- V García-Blázquez
- Department of Radiology, University Hospital Ramón y Cajal, Madrid, Spain
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