Araoz Philip A, Gotway Michael B, Harrington Jeffrey R, Harmsen W Scott, Mandrekar Jayawant N
Department of Radiology, Division of Biostatistics, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
Radiology. 2007 Mar;242(3):889-97. doi: 10.1148/radiol.2423051441.
To retrospectively determine whether three computed tomographic (CT) findings-ventricular septal bowing (VSB), ratio between the diameters of right ventricle (RV) and left ventricle (LV), and embolic burden-are associated with short-term death, defined as in-hospital death or death within 30 days of CT, whichever was longer, due to acute pulmonary embolism (PE).
Institutional Review Board approval was obtained, and patient information was reviewed in compliance with HIPAA regulations. A total of 1193 patients with CT scans positive for PE from January 1, 1997, to December 31, 2002, who had given authorization for retrospective research were included. Scans were independently reviewed by two observers. CT findings were compared with risk of death by using univariate analysis (chi(2) statistic) and multivariate logistic regression. Interobserver variability (kappa statistic or intraclass correlation coefficient), sensitivity, and specificity of CT findings for predicting death were calculated. A third observer reviewed discrepant cases post hoc.
Fifty-four percent of patients were women and 46% were men (mean age, 63 years +/- 16). For observer 1, VSB was associated with death in univariate (odds ratio [OR], 1.98; P = .04) and multivariate modeling (OR, 1.97; P = .05). Interobserver variability was only fair (kappa = 0.54) for VSB, and observer 2 found no association with death (OR, 1.52; P = .22). For both observers, VSB had low sensitivity (21% and 18%) and high specificity (88% and 87%) for predicting death. Neither RV/LV diameter ratio nor embolic burden was associated with increased risk of death. For observer 3, VSB was associated with death in univariate (OR, 2.10; P = .05) and multivariate analyses (OR, 2.18; P = .05).
CT-depicted VSB is predictive of death due to PE, but with low sensitivity and high interobserver variability. RV/LV diameter ratio and embolic burden are not associated with short-term death due to PE.
回顾性确定计算机断层扫描（CT）的三项表现——室间隔弓状隆起（VSB）、右心室（RV）与左心室（LV）直径之比以及栓塞负荷——是否与短期死亡相关，短期死亡定义为因急性肺栓塞（PE）导致的住院死亡或CT检查后30天内死亡（以较长者为准）。
获得机构审查委员会批准，并按照《健康保险流通与责任法案》（HIPAA）规定审查患者信息。纳入1997年1月1日至2002年12月31日期间1193例CT扫描显示PE阳性且已授权进行回顾性研究的患者。扫描结果由两名观察者独立评估。采用单因素分析（卡方统计量）和多因素逻辑回归分析将CT表现与死亡风险进行比较。计算观察者间变异性（kappa统计量或组内相关系数）、CT表现预测死亡的敏感性和特异性。第三名观察者事后复查存在分歧的病例。
54%的患者为女性，46%为男性（平均年龄63岁±16岁）。对于观察者1，VSB在单因素分析（比值比[OR]，1.98；P = 0.04）和多因素模型分析（OR，1.97；P = 0.05）中与死亡相关。VSB的观察者间变异性仅为中等（kappa = ），观察者2未发现其与死亡相关（OR，1.52；P = 0.22）。对于两名观察者而言，VSB预测死亡的敏感性均较低（分别为21%和18%），特异性较高（分别为88%和87%）。RV/LV直径比和栓塞负荷均与死亡风险增加无关。对于观察者3，VSB在单因素分析（OR，2.10；P = 0.05）和多因素分析（OR，2.18；P = 0.05）中与死亡相关。
CT显示的VSB可预测PE导致的死亡，但敏感性较低且观察者间变异性较高。RV/LV直径比和栓塞负荷与PE导致的短期死亡无关。
