Hurst D R, Kazerooni E A, Stafford-Johnson D, Williams D M, Platt J F, Cascade P N, Prince M R
Department of Radiology, The University of Michigan Medical Center, Ann Arbor 48109-0326, USA.
J Vasc Interv Radiol. 1999 Mar;10(3):309-18. doi: 10.1016/s1051-0443(99)70036-9.
To compare the sensitivity and specificity of helical computed tomographic angiography (CTA), CTA with multiplanar reconstructions (MPR)/three-dimensional-shaded surface display (3D-SSD), and gadolinium-enhanced magnetic resonance angiography (MRA) for pulmonary embolism (PE) detection.
Gelatin sponge emboli were introduced into the femoral veins of seven dogs and conventional digital subtraction angiography (CA), CTA, and MRA performed. Images from CTA, CTA with MPR/3D-SSD, and MRA were reviewed for the presence of PE in lobar and segmental arteries, and subsegmental zones. Postmortem angiography and CA were the gold standard.
There were 50 emboli in the 294 vessels/zones analyzed. The sensitivity of CTA for the two readers was 76% (95% confidence interval [CI]; 64%-88%) and 64% (95% CI; 50%-78%), and for the two MRA readers was 52% (95% CI; 38%-66%) and 48% (95% CI; 34%-62%). CTA was more sensitive than MRA when PE were subdivided by vessel caliber. Specificity was high for CTA and MRA among all readers (98.8%-99.6%). MPR/3D-SSD did not improve results of axial CT. MRA perfusion defects were 46% and 47% sensitive and 100% specific. Interobserver agreement was high for CTA and MRA (kappa 0.92 and 0.93, respectively). The average diameter of vessels with emboli was 3.7 mm +/- 1.06.
Helical CTA is more sensitive than three-dimensional gadolinium-enhanced MRA for the detection of PE. Both CTA and MRA are highly specific for PE detection and demonstrate high interobserver agreement. MPR/3D-SSD did not increase CTA performance over axial images alone.
比较螺旋计算机断层血管造影（CTA）、具有多平面重建（MPR）/三维表面阴影显示（3D-SSD）的CTA以及钆增强磁共振血管造影（MRA）检测肺栓塞（PE）的敏感性和特异性。
将明胶海绵栓子注入7只犬的股静脉，并进行传统数字减影血管造影（CA）、CTA和MRA检查。对CTA、具有MPR/3D-SSD的CTA以及MRA图像进行评估，以确定叶动脉、段动脉和亚段区域是否存在PE。尸检血管造影和CA为金标准。
在分析的294个血管/区域中共有50个栓子。两位CTA阅片者的敏感性分别为76%（95%置信区间[CI]；64%-88%）和64%（95%CI；50%-78%），两位MRA阅片者的敏感性分别为52%（95%CI；38%-66%）和48%（95%CI；34%-62%）。当根据血管管径对PE进行细分时，CTA比MRA更敏感。所有阅片者中CTA和MRA的特异性均较高（98.8%-99.6%）。MPR/3D-SSD并未改善轴向CT的结果。MRA灌注缺损的敏感性分别为46%和47%，特异性为100%。CTA和MRA的观察者间一致性较高（kappa分别为0.92和0.93）。有栓子的血管平均直径为3.7 mm±1.06。
螺旋CTA在检测PE方面比三维钆增强MRA更敏感。CTA和MRA在检测PE方面均具有高度特异性，且观察者间一致性较高。MPR/3D-SSD并未比单独的轴向图像提高CTA的性能。
