Weiss Clifford R, Scatarige John C, Diette Gregory B, Haponik Edward F, Merriman Barry, Fishman Elliot K
Russell H. Morgan Department of Radiology and Radiological Sciences, 601 N. Caroline Street, Room 3254, The Johns Hopkins University School of Medicine, Baltimore, MD 21287-0801, USA.
Acad Radiol. 2006 Apr;13(4):434-46. doi: 10.1016/j.acra.2006.01.002.
Our aim is to document current imaging practices for diagnosing acute pulmonary embolism (PE) among physicians practicing in the United States and explore factors associated with these practices.
Between September 2004 and February 2005, we surveyed by mail 855 physicians selected at random from membership lists of three professional organizations. Physicians reported their imaging practices and experiences in managing patients with suspected acute PE during the preceding 12 months.
Completed questionnaires were received from 240 of 806 eligible participants (29.8%) practicing in 44 states: 86.7% of respondents believed that computed tomographic pulmonary angiography (CTPA) was the most useful imaging procedure for patients with acute PE compared with 8.3% for ventilation-perfusion (V-P) scintigraphy and 2.5% for conventional pulminary angiography (PA). After chest radiography, CTPA was the first imaging test requested 71.4% of the time compared with V-P scintigraphy (19.7%) and lower-limb venous ultrasound (5.8%). Participants received indeterminate or inconclusive results 46.4% of the time for V-P scintigraphy, 10.6% of the time for CTPA, and 2.2% of the time for PA. CTPA was available around the clock to 88.3% of participants compared with 53.8% for V-P scintigraphy and 42.5% for PA. A total of 68.6% of respondents received CTPA results in 2 hours or less (vs 37.5% for V-P scintigraphy and 22.9% for PA). CTPA also provided an alternative diagnosis to PE or showed other significant abnormalities 28.5% of the time, and these findings frequently altered management.
US clinicians unequivocally prefer CTPA in patients with suspected acute PE. Reasons for this preference include availability and timely reporting, a lower rate of inconclusive results, and the additional diagnostic capabilities that CTPA can provide.
我们的目的是记录美国执业医师诊断急性肺栓塞（PE）的当前影像检查实践，并探讨与这些实践相关的因素。
在2004年9月至2005年2月期间，我们通过邮件对从三个专业组织成员名单中随机选取的855名医师进行了调查。医师们报告了他们在过去12个月中对疑似急性PE患者进行影像检查的实践和经验。
在44个州执业的806名合格参与者中有240名（29.8%）返回了完整问卷：86.7%的受访者认为计算机断层扫描肺动脉造影（CTPA）是急性PE患者最有用的影像检查方法，相比之下，通气灌注（V-P）闪烁扫描为8.3%，传统肺动脉造影（PA）为2.5%。胸部X线检查后，71.4%的情况下CTPA是首先被要求进行的影像检查，相比之下，V-P闪烁扫描为19.7%，下肢静脉超声为5.8%。V-P闪烁扫描结果不确定或无结论的情况占46.4%，CTPA为10.6%，PA为2.2%。88.3%的参与者可随时进行CTPA检查，相比之下，V-P闪烁扫描为53.8%，PA为42.5%。68.6%的受访者在2小时或更短时间内获得CTPA结果（V-P闪烁扫描为37.5%，PA为22.9%）。CTPA还在28.5%的情况下提供了PE的替代诊断或显示了其他显著异常，这些发现经常改变治疗方案。
美国临床医生在疑似急性PE患者中明确更倾向于CTPA。这种偏好的原因包括可及性和及时报告、无结论结果的发生率较低以及CTPA能够提供的额外诊断能力。
