Winer-Muram Helen T, Rydberg Jonas, Johnson Matthew S, Tarver Robert D, Williams Mark D, Shah Himanshu, Namyslowski Jan, Conces Dewey, Jennings S Gregory, Ying Jun, Trerotola Scott O, Kopecky Kenyon K
Department of Radiology, Division of Pulmonary, Critical Care, and Occupational Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
Radiology. 2004 Dec;233(3):806-15. doi: 10.1148/radiol.2333031744.
To determine diagnostic accuracy of four-channel multi-detector row computed tomography (CT) in emergency room and inpatient populations suspected of having acute pulmonary embolism (PE) who prospectively underwent both CT and pulmonary arteriography (PA).
Patients referred for PA to assess suspected PE were eligible. Institutional review board approval and written informed consent were obtained. All patients underwent CT and PA within a 48-hour period. For CT, 4 x 2.5-mm collimation was used. Three readers independently evaluated each study for PE presence. PE status, vessel level, and lobar location were determined by means of majority rule, and interobserver agreement (kappa) was calculated for PE status, as assessed with each modality. Sensitivity and specificity of CT were calculated by using PA as the reference standard. Two radiologists later reviewed false-positive CT studies.
The study group comprised 93 patients (median age, 56 years; range, 19-88 years). Sensitivity, specificity, and accuracy of CT were 100%, 89%, and 91%, respectively. kappa values were 0.71 and 0.83 for CT and PA, respectively, and were not significantly different between modalities. At PA, 18 patients (19%) had PE at 50 vessel levels (five main and/or interlobar, 24 segmental, and 21 subsegmental), 17 (94%) of which had PE at multiple sites. At CT, 26 patients (28%) had PE at 71 vessel levels (24 main and/or interlobar, 33 segmental, and 14 subsegmental). Twenty patients (77%) had PE at multiple sites. Review of eight false-positive CT studies showed an appearance highly suggestive of acute PE in three patients, chronic PE in one, and no PE in three; one study was inconclusive. CT better demonstrated large-level vessel involvement (P < .01), while PA better demonstrated small-level vessel involvement (P < .01).
Multi-detector row CT has an accuracy of 91% in the depiction of suspected acute PE when conventional PA is used as the reference standard.
确定四通道多排螺旋计算机断层扫描（CT）对急诊室和住院患者中疑似急性肺栓塞（PE）患者的诊断准确性，这些患者前瞻性地接受了CT和肺动脉造影（PA）检查。
因疑似PE而转诊接受PA检查的患者符合条件。获得了机构审查委员会的批准和书面知情同意书。所有患者在48小时内接受了CT和PA检查。对于CT，采用4×2.5毫米的准直。三名阅片者独立评估每项研究中是否存在PE。通过多数表决法确定PE状态、血管水平和肺叶位置，并计算每种检查方式评估PE状态时的观察者间一致性（kappa）。以PA作为参考标准计算CT的敏感性和特异性。两名放射科医生随后复查了CT假阳性研究。
研究组包括93例患者（中位年龄56岁；范围19 - 88岁）。CT的敏感性、特异性和准确性分别为100%、89%和91%。CT和PA的kappa值分别为0.71和0.83，两种检查方式之间无显著差异。在PA检查中，18例患者（占19%）在50个血管水平存在PE（5个主肺动脉和/或叶间动脉、24个节段动脉和21个亚段动脉），其中17例（占94%）在多个部位存在PE。在CT检查中，26例患者（占28%）在71个血管水平存在PE（24个主肺动脉和/或叶间动脉、33个节段动脉和14个亚段动脉）。20例患者（占77%）在多个部位存在PE。对8例CT假阳性研究的复查显示，3例患者的表现高度提示急性PE，1例提示慢性PE，3例提示无PE；1例研究结果不确定。CT能更好地显示大血管水平的受累情况（P < 0.01），而PA能更好地显示小血管水平的受累情况（P < 0.01）。
以传统PA作为参考标准时，多排螺旋CT对疑似急性PE的诊断准确性为91%。
