Goodman Lawrence R, Stein Paul D, Matta Fadi, Sostman H Dirk, Wakefield Thomas W, Woodard Pamela K, Hull Russell, Yankelevitz David F, Beemath Afzal
Department of Diagnostic Radiology, Medical College of Wisconsin, 9200 W Wisconsin Ave., Milwaukee, WI 53226-3596, USA.
AJR Am J Roentgenol. 2007 Nov;189(5):1071-6. doi: 10.2214/AJR.07.2388.
The purpose of this study was to compare the clinical value of CT venography (CTV) after MDCT angiography (CTA) with venous compression sonography for the diagnosis of venous thromboembolism (VTE). The Prospective Investigation of Pulmonary Embolism Diagnosis II (PIOPED II) showed that lower extremity imaging detects about 7% more patients requiring anticoagulation than CTA alone.
PIOPED II was a prospective multicenter study investigating the accuracy of CTA alone and CTA and CTV together. A composite reference standard was used to confirm, or rule out, pulmonary embolus. Adequate quality CTV and sonographic images were obtained in 711 patients.
There was 95.5% concordance between CTV and sonography for the diagnosis or exclusion of deep venous thrombosis (DVT); the kappa statistic was 0.809. The sensitivity and specificity of combined CTA and CTV were equivalent to those of combined CTA and sonography. Diagnostic results in subgroups, including patients with signs or symptoms of DVT, asymptomatic patients, and patients with a history of DVT, were similar whether CTV or sonography was used. Patients with signs or symptoms of DVT were eight times more likely to have DVT, and patients with a history of DVT were twice as likely to have positive findings.
CTV and sonography showed similar results in diagnosing or excluding DVT. The incidence of positive studies in patients without signs, symptoms, or history of DVT is low. In terms of clinical significance, CT venography and lower extremity sonography yield equivalent diagnostic results; the incidence of positive studies in patients without signs, symptoms, or history of DVT is low; thus the choice of imaging technique can be made on the basis of safety, expense, and time constraints.
本研究旨在比较多层螺旋CT血管造影（CTA）后CT静脉成像（CTV）与静脉压迫超声检查对静脉血栓栓塞症（VTE）的诊断临床价值。肺栓塞诊断前瞻性调查II（PIOPED II）研究表明，与单独使用CTA相比，下肢成像能多检测出约7%需要抗凝治疗的患者。
PIOPED II是一项前瞻性多中心研究，旨在调查单独使用CTA以及联合使用CTA和CTV的准确性。采用综合参考标准来确诊或排除肺栓塞。711例患者获得了质量合格的CTV和超声图像。
CTV与超声检查在诊断或排除深静脉血栓形成（DVT）方面的一致性为95.5%；kappa统计值为0.809。联合CTA和CTV的敏感性和特异性与联合CTA和超声检查相当。无论使用CTV还是超声检查，包括有DVT体征或症状的患者、无症状患者以及有DVT病史的患者等亚组的诊断结果相似。有DVT体征或症状的患者发生DVT的可能性高8倍，有DVT病史的患者出现阳性结果的可能性高2倍。
CTV与超声检查在诊断或排除DVT方面结果相似。无DVT体征、症状或病史的患者检查结果为阳性的发生率较低。就临床意义而言，CT静脉成像和下肢超声检查产生的诊断结果相当；无DVT体征、症状或病史的患者检查结果为阳性的发生率较低；因此，可根据安全性、费用和时间限制来选择成像技术。
