Blum Alain, Bellou Abdelouahab, Guillemin Francis, Douek Philippe, Laprévote-Heully Marie-Claude, Wahl Denis
Service d'Imagerie Guilloz, Centre Hospitalier Universitaire Nancy, France.
Thromb Haemost. 2005 Mar;93(3):503-11. doi: 10.1160/TH04-08-0495.
Pulmonary embolism (PE) is a common and potentially fatal disorder. Non-specific findings make the clinical diagnosis of PE difficult. To assess the diagnostic value and inter-observer agreement of magnetic resonance angiography (MRA) in a cohort of patients with suspected PE, we conducted a prospective clinical study. MRA was compared for sensitivity and specificity to a diagnostic strategy including clinical probability, D-dimer testing, spiral CT, ultrasound leg compression and pulmonary angiography. A total of 89 patients with clinically suspected PE were included: the clinical probability of PE was intermediate or high in 78, and low in the remaining 11. All patients underwent monoor multi-slice spiral CT and MRA with gadolinium injection (both within 24 hours of entry to the study). Anticoagulation was withheld in patients concerned about the strategy. All subjects were followed up for 3 months. MRA was read independently by two experienced teams of radiologists: one local and one from another university centre. Spiral CT was positive in 62 of 63 cases of confirmed PE. No patient with negative CT findings was positive ultrasonographically. Only one patient with a negative CT (and negative ultrasound) had a recurrent thromboembolic event. The first team diagnosed PE with MRA in 47 cases, with a sensitivity of 71% and a specificity of 92%; the second team obtained the diagnosis in 23 cases, with a sensitivity of 31% and a specificity of 85%. Inter-observer agreement between MRA reading was low: Kappa = 0.16 (-0.01 to 0.33); p = 0.07. In conclusion, compared with a non-invasive strategy based on spiral CT, the diagnostic value of MRA is limited by poor inter-observer agreement.
肺栓塞（PE）是一种常见且可能致命的疾病。非特异性表现使得PE的临床诊断较为困难。为了评估磁共振血管造影（MRA）在疑似PE患者队列中的诊断价值及观察者间的一致性，我们进行了一项前瞻性临床研究。将MRA的敏感性和特异性与包括临床概率、D - 二聚体检测、螺旋CT、下肢超声压迫检查和肺血管造影在内的诊断策略进行比较。共有89例临床疑似PE的患者纳入研究：其中78例PE的临床概率为中度或高度，其余11例为低度。所有患者均在进入研究的24小时内接受了单层或多层螺旋CT及注射钆对比剂的MRA检查。对参与该策略研究的患者暂未进行抗凝治疗。所有受试者均随访3个月。MRA由两组经验丰富的放射科医生独立解读：一组来自本地，另一组来自另一所大学中心。在63例确诊的PE病例中，螺旋CT有62例呈阳性。CT检查结果为阴性的患者超声检查均未呈阳性。只有1例CT检查结果为阴性（且超声检查也为阴性）的患者发生了复发性血栓栓塞事件。第一组通过MRA诊断出47例PE，敏感性为71%，特异性为92%；第二组诊断出23例，敏感性为31%，特异性为85%。MRA解读的观察者间一致性较低：Kappa值 = 0.16（-0.01至0.33）；p = 0.07。总之，与基于螺旋CT的非侵入性策略相比，MRA的诊断价值因观察者间一致性差而受限。
