Stein Paul D, Hull Russell D
St Joseph Mercy Oakland Hospital, Pontiac, Michigan 48341-5023, USA.
Curr Opin Pulm Med. 2007 Sep;13(5):384-8. doi: 10.1097/MCP.0b013e32821acdbe.
This review describes the accuracy of multidetector contrast-enhanced computed tomography (CT) for the diagnosis of acute pulmonary embolism, the role of clinical assessment and of venous phase imaging in combination with it, and the approach to the diagnosis.
The sensitivity of CT angiography was 83%, specificity 96% and positive predictive value 86%. Positive predictive values were 97% for pulmonary embolism in a main or lobar artery, 68% for a segmental vessel, and 25% for a subsegmental branch. A CT angiogram with concordant clinical probability assessment resulted in high predictive values, but with a discordant clinical probability, predictive value was low. The sensitivity for pulmonary embolism increased to 90% by using CT venography in combination with CT angiography.A negative D-dimer by the rapid enzyme-linked immunosorbent assay method with a low or moderate probability clinical assessment can safely exclude pulmonary embolism. Clinical probability assessment and D-dimer are recommended. In general, CT angiography in combination with CT venography is recommended, but the choice of diagnostic tests depends on the clinical situation.
The reliability of multislice CT angiography is enhanced by clinical assessment and CT venography used with it. Clinical assessment and D-dimer are recommended before imaging.
本综述描述了多排螺旋CT增强扫描在急性肺栓塞诊断中的准确性、临床评估及静脉期成像与其联合应用的作用，以及诊断方法。
CT血管造影的敏感性为83%，特异性为96%，阳性预测值为86%。主肺动脉或叶动脉内肺栓塞的阳性预测值为97%，段血管为68%，亚段分支为25%。CT血管造影与临床概率评估结果一致时预测值较高，但临床概率不一致时预测值较低。联合CT静脉造影时，肺栓塞的敏感性提高到90%。采用快速酶联免疫吸附法检测D-二聚体，临床评估为低度或中度可能性时，D-二聚体阴性可安全排除肺栓塞。推荐进行临床概率评估和D-二聚体检测。一般推荐CT血管造影联合CT静脉造影，但诊断检查的选择取决于临床情况。
临床评估及与之联合应用的CT静脉造影可提高多层螺旋CT血管造影的可靠性。建议在进行影像学检查前先进行临床评估和D-二聚体检测。
