多排螺旋CT肺血管造影和间接静脉造影在重症监护病房患者静脉血栓栓塞性疾病诊断中的应用

Multidetector row CT pulmonary angiography and indirect venography for the diagnosis of venous thromboembolic disease in intensive care unit patients.

作者信息

Kelly Aine M, Patel Smita, Carlos Ruth C, Cronin Paul, Kazerooni Ella A

机构信息

Department of Radiology, Division of Thoracic Radiology, University of Michigan Medical Center, Ann Arbor, MI 48109-0030, USA.

出版信息

Acad Radiol. 2006 Apr;13(4):486-95. doi: 10.1016/j.acra.2006.01.041.

DOI:10.1016/j.acra.2006.01.041

PMID:16554229

Abstract

RATIONALE AND OBJECTIVES

To determine the diagnostic quality, performance characteristics and interreader reliability of computed tomography pulmonary angiography (CTPA) and venography (CTV) in intensive care unit (ICU) patients with suspected venous thromboembolism (VTE).

MATERIALS AND METHODS

A total of 100 consecutive ICU patient CT examinations performed for clinically suspected VTE on a four-row CT scanner were reviewed. Three readers rated the diagnostic quality of each CTPA and CTV examination as excellent, acceptable, or nondiagnostic. Readers scored the overall determination for pulmonary embolism (PE) and deep venous thrombosis (DVT) using a 5-point scale, and scored the determination for PE by anatomic level. Receiver operator characteristic (ROC) analysis was performed for each reader and the original clinical report, using consensus interpretation as the reference standard. Interobserver variability for PE and DVT was determined using kappa analysis, and was stratified by examination quality.

RESULTS

A total of 25% of CTPA examinations were nondiagnostic, most commonly because of motion artifact and poor contrast opacification. A total of 24% of CTV examinations were nondiagnostic, most commonly because of poor contrast opacification and metallic hardware. Using receiver operating characteristic analysis, the areas under the curve (Az) for PE diagnosis were 0.875, 0.923, 0.888, and 0.674 for the three readers and clinical reading, respectively, and for DVT diagnosis were 0.842, 0.859, 0.952 and 0.669. Interobserver agreement for detection of PE was moderate at the supralobar level (kappa = 0.55), very good at the lobar level (kappa = 0.69), and moderate for segmental (kappa = 0.54) and subsegmental arteries (kappa = 0.44). Overall reader agreement was good for excellent/good quality CTPA examinations (kappa = 0.52-0.56), and poor when examination quality was poor (kappa = 0.06).

CONCLUSIONS

CTPA and CTV are sufficiently accurate and reliable techniques for evaluating VTE in ICU patients, particularly in light of patient complexity.

摘要

原理与目的

确定计算机断层扫描肺动脉造影（CTPA）和静脉造影（CTV）在疑似静脉血栓栓塞症（VTE）的重症监护病房（ICU）患者中的诊断质量、性能特征及阅片者间可靠性。

材料与方法

回顾了在一台四排CT扫描仪上对100例因临床怀疑VTE而进行CT检查的连续ICU患者。三位阅片者将每次CTPA和CTV检查的诊断质量评为优秀、可接受或无法诊断。阅片者使用5分制对肺栓塞（PE）和深静脉血栓形成（DVT）的总体判定进行评分，并按解剖水平对PE的判定进行评分。以共识解读作为参考标准，对每位阅片者和原始临床报告进行受试者操作特征（ROC）分析。使用kappa分析确定PE和DVT的观察者间变异性，并按检查质量进行分层。

结果

共有25%的CTPA检查无法诊断，最常见的原因是运动伪影和对比剂充盈不佳。共有24%的CTV检查无法诊断，最常见的原因是对比剂充盈不佳和金属植入物。使用受试者操作特征分析，三位阅片者和临床阅片对PE诊断的曲线下面积（Az）分别为0.875、0.923、0.888和0.674，对DVT诊断的曲线下面积分别为0.842、0.859、0.952和0.669。在叶上水平，观察者间对PE检测的一致性为中等（kappa = 0.55），在叶水平为很好（kappa = 0.69），在段和亚段动脉水平为中等（kappa = 0.54）和较差（kappa = 0.44）。对于优秀/良好质量的CTPA检查，阅片者总体一致性良好（kappa = 0.52 - 0.56），而当检查质量较差时一致性较差（kappa = 0.06）。