Macdonald W B G, Patrikeos A P, Thompson R I, Adler B D, van der Schaaf A A
Department of Nuclear Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
Australas Radiol. 2005 Feb;49(1):32-8. doi: 10.1111/j.1440-1673.2005.01390.x.
The present study compared the accuracy of ventilation perfusion scintigraphy (VQS) and CT pulmonary angiography (CTPA) for the diagnosis of pulmonary embolism. This was a prospective observational study of 112 patients with suspected pulmonary embolism (PE) who could be studied with both investigations within 24 h. Results were compared to final diagnosis at completion of 6-month follow up, using receiver operating characteristic (ROC) analysis. Pulmonary embolism was diagnosed in 27 referred patients (24%). The sensitivity and specificity of VQS and CTPA were similar to that reported from the literature. A normal VQ scan had the highest negative predictive value (100%), while a high-probability VQ scan had the highest positive predictive value (92%). There was no overall difference (area under the ROC curve (AUC)) between VQS (AUC (95% CI) = 0.82 (0.75,0.89)) and CTPA (AUC = 0.88 (0.81,0.94)) for the diagnosis of PE. Among patients with abnormal chest X-rays, CTPA (AUC 0.90 (0.83,0.97)) appeared somewhat better than VQS (AUC 0.78 (0.68,0.88)) but this difference did not reach statistical significance. In this instance, CTPA is at least as accurate as VQS and may provide an opportunity to make alternative diagnoses.
本研究比较了通气灌注闪烁扫描（VQS）和CT肺血管造影（CTPA）在诊断肺栓塞方面的准确性。这是一项对112例疑似肺栓塞（PE）患者的前瞻性观察性研究，这些患者能够在24小时内接受这两种检查。使用受试者工作特征（ROC）分析，将结果与6个月随访结束时的最终诊断进行比较。在27例转诊患者中诊断出肺栓塞（24%）。VQS和CTPA的敏感性和特异性与文献报道相似。正常的VQ扫描具有最高的阴性预测值（100%），而高概率的VQ扫描具有最高的阳性预测值（92%）。在诊断PE方面，VQS（曲线下面积（AUC）（95%可信区间）=0.82（0.75,0.89））和CTPA（AUC = 0.88（0.81,0.94））之间没有总体差异。在胸部X光异常的患者中，CTPA（AUC 0.90（0.83,0.97））似乎比VQS（AUC 0.78（0.68,0.88））稍好，但这种差异未达到统计学意义。在这种情况下，CTPA至少与VQS一样准确，并且可能提供做出其他诊断的机会。
