Lu Michael T, Cai Tianxi, Ersoy Hale, Whitmore Amanda G, Quiroz Rene, Goldhaber Samuel Z, Rybicki Frank J
Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
Radiology. 2008 Jan;246(1):281-7. doi: 10.1148/radiol.2461062004.
To retrospectively determine if the interval increase of right ventricular-left ventricular (RV/LV) diameter ratio from negative prior to positive current computed tomographic (CT) examination findings for pulmonary embolism (PE) is more accurate for predicting 30-day mortality than positive CT ratio alone, by using patient 30-day mortality as reference standard.
This IRB-approved, HIPAA-compliant study had waiver of informed consent and retrospectively reviewed 50 patients (19 men, 31 women; mean age, 60 years) with negative prior and positive current CT findings for acute PE (median interval, 63 days). Interval increase was defined as percentage change in RV/LV diameter ratio by using reformatted four-chamber views. Receiver operating characteristic (ROC) analysis compared the interval increase with the RV/LV diameter ratio from the positive findings alone for PE-related and all-cause mortality.
Twelve (24%) patients died in 30 days; nine were PE-related. The interval increase was significantly more accurate overall than the ratio from the positive study alone for PE-related (area under the ROC curve [AUC] = 0.95 vs 0.73, P = .003) and all-cause (AUC = 0.81 vs 0.66, P = .05) mortality. The respective sensitivity, specificity, positive predictive value, and negative predictive value were 0.78 (seven of nine; 95% confidence interval [CI]: 0.43, 1.00), 0.93 (38 of 41; 95% CI: 0.83, 1.00), 0.70 (seven of 10; 95% CI: 0.38, 1.00), and 0.95 (38 of 40; 95% CI: 0.87, 1.00) for PE-related mortality (interval increase, >18%) and 0.75 (nine of 12; 95% CI: 0.49, 1.00), 0.89 (34 of 38; 95% CI: 0.80, 0.99), 0.69 (nine of 13; 95% CI: 0.44, 0.95), and 0.92 (34 of 37; 95% CI: 0.83, 1.00) for all-cause mortality (interval increase, >15%). At target sensitivity (0.75), specificity of interval increase was significantly higher than from positive scans alone for both PE-related (0.93 vs 0.59, P = .001) and all-cause (0.89 vs 0.58, P = .05) mortality.
The interval increase in four-chamber RV/LV diameter ratio is more accurate than the diameter ratio of the CT examination with with positive findings for PE alone for mortality prediction after acute PE.
以患者30天死亡率作为参考标准，回顾性确定在肺栓塞（PE）的计算机断层扫描（CT）检查中，右心室与左心室（RV/LV）直径比值从之前的阴性变为当前的阳性时，其间隔期增加量在预测30天死亡率方面是否比单纯的阳性CT比值更准确。
这项经机构审查委员会（IRB）批准且符合健康保险流通与责任法案（HIPAA）的研究豁免了知情同意书，并回顾性分析了50例患者（19例男性，31例女性；平均年龄60岁），这些患者之前的CT检查结果为阴性，而当前的CT检查结果为急性PE阳性（中位间隔期为63天）。间隔期增加量定义为使用重组四腔心视图计算的RV/LV直径比值的百分比变化。受试者操作特征（ROC）分析比较了间隔期增加量与仅根据阳性结果得出的RV/LV直径比值对PE相关死亡率和全因死亡率的预测情况。
12例（24%）患者在30天内死亡；其中9例与PE相关。总体而言，间隔期增加量在预测PE相关死亡率（ROC曲线下面积[AUC]=0.95对0.73，P=0.003）和全因死亡率（AUC=0.81对0.66，P=0.05）方面比仅根据阳性检查得出的比值更准确。对于PE相关死亡率（间隔期增加量>18%），其敏感性、特异性、阳性预测值和阴性预测值分别为0.78（9例中的7例；95%置信区间[CI]：0.43，1.00）、0.93（41例中的38例；95%CI：0.83，1.00）、0.70（10例中的7例；95%CI：0.38，1.00）和0.95（40例中的38例；95%CI：,0.87，1.00）；对于全因死亡率（间隔期增加量>15%），其敏感性、特异性、阳性预测值和阴性预测值分别为0.75（12例中的9例；95%CI：0.49，1.00）、0.89（38例中的34例；95%CI：0.80，0.99）、0.69（13例中的9例；95%CI：0.44，0.95）和0.92（37例中的34例；95%CI：0.83，1.00）。在目标敏感性（0.75）下，间隔期增加量的特异性在预测PE相关死亡率（0.93对0.59，P=0.001）和全因死亡率（0.89对0.58，P=0.05）方面均显著高于仅根据阳性扫描得出的结果。
四腔心RV/LV直径比值间隔期增加量在预测急性PE后的死亡率方面比仅根据PE阳性结果的CT检查直径比值更准确。
