Rhee Kyung Hwa, Iyer Ramesh S, Cha Susan, Naidich David P, Rusinek Henry, Jacobowitz Glenn R, Ko Jane P
Department of Radiology, NYU Medical Center, New York, NY 10016, USA.
Clin Imaging. 2007 Jul-Aug;31(4):253-8. doi: 10.1016/j.clinimag.2007.02.027.
The aim of this study was to determine the benefit of lower extremity CT venography (CTV) with pulmonary CT angiography (CTA) for diagnosing thromboembolic (TE) disease.
Reports of all CTAs and CTVs over a 3-year interval (Group I) and CTAs, CTVs, and lower extremity Doppler ultrasounds (US) over a 1 1/2-year subset (Group II) were reviewed. Patient population was inpatients and emergency department patients who were assessed for pulmonary embolism (PE) and deep venous thrombosis (DVT) at a tertiary care hospital. Reported results for CTA or CTV were categorized as positive (CTA(P), CTV(P)), negative (CTA(N), CTV(N)), or indeterminate for PE or DVT. When CTV and US results were discrepant, medical records were reviewed for clinical management. Additional benefit of CTV was assessed by chi-square analysis.
In Group I, 737 (81.1%) of 909 CTAs from combined CTA/CTV studies were negative. The diagnosis rate of TE disease increased from 13.0% to 17.3% with the addition of CTV(P)s (P=.01). Of the 119 cases in Group II undergoing combined CTA, CTV, and US, CTV and US were both positive in eight and both negative in 88. Of the seven discordant CTVs and USs with clinical follow-up, five CTVs were positive while USs were negative, three of which were treated clinically for TE disease, while two were considered falsely positive. As CTA also proved positive in one of the three, CTV therefore affected management in two of these five cases and increased the rate of thromboembolism diagnosis from 21.0% to 22.6%; however, this was not significant (P>.05). Two CTV(N)s were managed as false negatives.
The combined use of CTA and CTV significantly increases the rate of TE disease over CTA alone. In cases in which ultrasound is performed, however, there is no significant advantage to performing combined CTA/CTV studies.
本研究旨在确定下肢CT静脉造影（CTV）联合肺部CT血管造影（CTA）诊断血栓栓塞性（TE）疾病的益处。
回顾了3年期间所有CTA和CTV的报告（第一组）以及1.5年亚组中CTA、CTV和下肢多普勒超声（US）的报告（第二组）。患者群体为在三级护理医院接受肺栓塞（PE）和深静脉血栓形成（DVT）评估的住院患者和急诊科患者。CTA或CTV报告的结果分为阳性（CTA(P)，CTV(P)）、阴性（CTA(N)，CTV(N)）或PE或DVT不确定。当CTV和US结果不一致时，查阅病历以了解临床管理情况。通过卡方分析评估CTV的额外益处。
在第一组中，来自CTA/CTV联合研究的909例CTA中有737例（81.1%）为阴性。加上CTV(P)后，TE疾病的诊断率从13.0%提高到17.3%（P = 0.01）。在第二组接受CTA、CTV和US联合检查的119例病例中，CTV和US均为阳性的有8例，均为阴性的有88例。在7例临床随访的CTV和US结果不一致的病例中，5例CTV为阳性而US为阴性，其中3例接受了TE疾病的临床治疗，2例被认为是假阳性。由于在这3例中的1例CTA也被证明为阳性，因此CTV在这5例中的2例中影响了治疗管理，并将血栓栓塞诊断率从21.0%提高到22.6%；然而，这并不显著（P>0.05）。2例CTV(N)被当作假阴性处理。
与单独使用CTA相比，CTA和CTV联合使用显著提高了TE疾病的诊断率。然而，在进行超声检查的情况下，进行CTA/CTV联合研究没有显著优势。
