Le Gal G, Righini M, Parent F, van Strijen M, Couturaud F
Department of Internal Medicine and Chest Diseases, EA 3878 (Groupe d'Etude de la Thrombose de Bretagne Occidentale), Brest University Hospital, Brest, France.
J Thromb Haemost. 2006 Apr;4(4):724-31. doi: 10.1111/j.1538-7836.2006.01819.x.
Although the advent of multi-detector row computed tomography (CT) has enabled better visualization of subsegmental pulmonary (SSP) arteries, SSP embolism is of uncertain clinical significance. We aimed at answering the following questions: Is spiral CT an accurate method to detect SSP embolism? How are subsegmental perfusion defects managed in outcome studies including spiral CT? What are the main characteristics and outcomes of patients in whom CT detects isolated subsegmental defects?
We performed a Medline search on July 1, 2004, using the keywords 'pulmonary embolism' and 'computed tomography'. We limited our search to English language prospective studies comparing CT to pulmonary angiography, and to prospective outcome studies including CT in a diagnostic strategy, with at least a 3-month follow-up.
Fourteen studies comparing CT to pulmonary angiography, and five prospective management studies using CT were retrieved. The sensitivity of single-detector CT for detecting subsegmental defects compared with pulmonary angiography was low (25%). The proportion of isolated SSP images was significantly higher in management studies using multi-detector CT (17 of 770 scans, 2.2%) compared with those using single-detector CT (22 of 2232, 1.0%; P = 0.01). No straightforward attitude regarding anticoagulation therapy for isolated subsegmental defects emerged from the available literature. Finally, important clinical differences were found between patients having subsegmental and segmental or more proximal defects.
These findings underline the uncertainty regarding the clinical significance of SSP embolism, and the management of patients with such findings.
尽管多排螺旋计算机断层扫描（CT）的出现使亚段肺动脉（SSP）能得到更好的可视化，但SSP栓塞的临床意义尚不确定。我们旨在回答以下问题：螺旋CT是检测SSP栓塞的准确方法吗？在包括螺旋CT的结果研究中，亚段灌注缺损如何处理？CT检测到孤立亚段缺损的患者的主要特征和结果是什么？
我们于2004年7月1日在Medline数据库进行检索，使用关键词“肺栓塞”和“计算机断层扫描”。我们将检索范围限制为比较CT与肺血管造影的英文前瞻性研究，以及在诊断策略中包括CT且随访至少3个月的前瞻性结果研究。
检索到14项比较CT与肺血管造影的研究，以及5项使用CT的前瞻性处理研究。与肺血管造影相比，单排CT检测亚段缺损的敏感性较低（25%）。与使用单排CT的处理研究（2232例中的22例，1.0%）相比，使用多排CT的处理研究中孤立SSP影像的比例显著更高（770例扫描中的17例，2.2%；P = 0.01）。现有文献未就孤立亚段缺损的抗凝治疗给出明确态度。最后，发现有亚段缺损的患者与有段或更近端缺损的患者之间存在重要临床差异。
这些发现凸显了SSP栓塞临床意义以及此类发现患者处理方面的不确定性。
