Grenier P A, Beigelman C
Department of Radiology, Pitié-Salpêtrière Hospital, Paris, France.
Thorax. 1998 Aug;53 Suppl 2(Suppl 2):S25-31. doi: 10.1136/thx.53.2008.s25.
To compare prospectively the accuracy of spiral computed tomography (CT) with that of ventilation-perfusion scintigraphy for diagnosing pulmonary embolism.
Within 48 hours of presentation, 142 patients suspected of having pulmonary embolism underwent spiral CT, scintigraphy, and (when indicated) pulmonary angiography. Pulmonary angiography was attempted if interpretations of spiral CT scans and of scintigrams were discordant or indeterminate and intermediate-probability, respectively.
In the 139 patients who completed the study, interpretations of spiral CT scans and of scintigrams were concordant in 103 patients (29 with embolism, 74 without). In 20 patients, intermediate-probability scintigrams were interpreted (six with embolism at angiography, 14 without); diagnosis with spiral CT was correct in 16. Interpretations of spiral CT scans and those of scintigrams were discordant in 12 cases; diagnosis with spiral CT was correct in 11 cases and that with scintigraphy was correct in one. Spiral CT and scintigraphic scans of four patients with embolism did not show embolism. Sensitivities, specificities, and kappa values with spiral CT and scintigraphy were 87%, 95%, and 0.85 and 65%, 94%, and 0.61, respectively.
In cases of pulmonary embolism, sensitivity of spiral CT is greater than that of scintigraphy. Interobserver agreement is better with spiral CT.
前瞻性比较螺旋计算机断层扫描（CT）与通气灌注闪烁扫描诊断肺栓塞的准确性。
在就诊48小时内，142例疑似肺栓塞患者接受了螺旋CT、闪烁扫描以及（必要时）肺血管造影检查。如果螺旋CT扫描和闪烁扫描结果不一致或不确定，且闪烁扫描结果为中度可能性，则尝试进行肺血管造影。
在完成研究的139例患者中，螺旋CT扫描和闪烁扫描结果在103例患者中一致（29例有栓塞，74例无栓塞）。20例患者闪烁扫描结果为中度可能性（6例血管造影显示有栓塞，14例无栓塞）；螺旋CT诊断正确的有16例。螺旋CT扫描和闪烁扫描结果不一致的有12例；螺旋CT诊断正确的有11例，闪烁扫描诊断正确的有1例。4例有栓塞的患者螺旋CT和闪烁扫描均未显示栓塞。螺旋CT和闪烁扫描的敏感性、特异性及kappa值分别为87%、95%、0.85和65%、94%、0.61。
在肺栓塞病例中，螺旋CT的敏感性高于闪烁扫描。螺旋CT的观察者间一致性更好。
