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• W2083339204 abstract "Objective: Arterial disease is best characterized by a continuous measure of severity (the % diameter reduction) rather than as a dichotomous condition. Doppler measurements provide a continuous test result related to the severity of stenosis. Given a continuous diagnostic test result, we demonstrate a model to compute the optimal test threshold for the decision to treat or withhold treatment. Methods: Let x denote the severity of disease; g(x) is the distribution of x in the population. Let y denote the test result; f(y|x) is the distribution of y given x. Assume that g(x) and f(y|x) are normally distributed, that the expected value of y is linearly related to the severity of disease, and that the utility of treatment is linearly related to the severity of disease. We apply this model to study data derived from a prior article on Doppler detection of renal artery stenosis (Radiology 1995, 195:799–804). Results: By extending Baye’s theorem, we demonstrate that for any particular value y of the diagnostic test, x is normally distributed. The distribution of x given y is denoted as h(x|y) with a mean and variance that may be computed from the means and variances of g(x) and f(y|x). Empirical analysis of our study data suggests that, for evaluation of renal artery stenosis, g(x) is best approximated by a mixture of normal distributions for healthy and diseased arteries, gh(x) and gd(x), rather than by a single normal distribution. We extend our model to this case to demonstrate that h(x|y) and hence the expected value of x given y may still be computed from the underlying distributions of g(x) and f(y|x). A unique optimal test threshold can be computed as long as the variance of gh(x) is less than the variance of gd(x). Our study data clearly conform to this restriction. Conclusions: When disease is characterized by a continuous level of severity, the expected utility of treatment may be derived from a diagnostic test result by computing the expected value of disease severity. For the diagnosis of renal artery stenosis, a unique optimal test threshold can be defined corresponding to the minimum test value that yields a positive expected utility." @default.
• W2083339204 created "2016-06-24" @default.
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• W2083339204 date "2003-05-01" @default.
• W2083339204 modified "2023-09-27" @default.
• W2083339204 title "Doppler detection of arterial stenosis: defining the optimal threshold for a diagnostic test when disease is characterized by a continuous level of severity" @default.
• W2083339204 doi "https://doi.org/10.1016/s0301-5629(03)00584-2" @default.
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