接受肺部CT血管造影的患者的常规盆腔和下肢CT静脉造影。

Routine pelvic and lower extremity CT venography in patients undergoing pulmonary CT angiography.

作者信息

Hunsaker Andetta R, Zou Kelly H, Poh Angeline C, Trotman-Dickenson Beatrice, Jacobson Francine L, Gill Ritu R, Goldhaber Samuel Z

机构信息

Department of Radiology, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115, USA.

出版信息

AJR Am J Roentgenol. 2008 Feb;190(2):322-6. doi: 10.2214/AJR.07.2568.

DOI:10.2214/AJR.07.2568

PMID:18212216

Abstract

OBJECTIVE

The purpose of our study was to assess the utility of performing routine pelvic and lower extremity CT venography (CTV) along with pulmonary CT angiography (CTA) in all patients evaluated for pulmonary embolism.

MATERIALS AND METHODS

Eight hundred twenty-nine consecutive patients (281 men and 548 women) underwent CTA-CTV for pulmonary embolism. Reports were evaluated as follows: positive or negative for pulmonary embolism with or without deep venous thrombosis (DVT) or with nondiagnostic CTV. Coexisting factors of malignancy, previous venous thromboembolism (VTE), recent surgery, and cardiovascular disease comprised the high-risk group of 446 patients. The remaining 383 patients formed the low-risk group. Statistical analysis included four binary predictors (previous VTE, malignancy, cardiovascular disease, and surgery) and three binary outcome variables (pulmonary embolism, DVT, and VTE). Chi-square test and univariate and multivariate regression analyses were performed.

RESULTS

VTE, pulmonary embolism, and DVT occurred in 152 (18.3%), 124 (15.0%), and 61 (7.3%) of 829 patients, respectively. Between the high-risk and low-risk groups, prevalence of VTE was 114 (25.6%) of 446 and 38 (9.9%) of 383 patients, respectively (p < 0.001); prevalence of pulmonary embolism was 92 (20.6%) of 446 and 32 (8.3%) of 383 patients, respectively (p < 0.001). Isolated DVT was found in 28 (3.4%) of 829 patients. The incremental value of CTV for the entire cohort was 3.4%, 0.72% in the low-risk group (six of 829) and 2.6% (22 of 829) in the high-risk group. For outcome variable VTE, malignancy and previous VTE were statistically significant (p = 0.04 and p < 0.001, respectively); for pulmonary embolism, malignancy and previous VTE were statistically significant (p = 0.03 and p = 0.005, respectively); for DVT, only previous VTE was statistically significant (p < 0.001).

CONCLUSION

CTV should not be performed routinely in all patients evaluated for pulmonary embolism and may only be useful in patients with a high probability of pulmonary embolism, including those with a history of VTE and possible malignancy.

摘要

目的

我们研究的目的是评估在所有接受肺栓塞评估的患者中，同时进行常规盆腔和下肢CT静脉造影（CTV）及肺CT血管造影（CTA）的效用。

材料与方法

829例连续患者（281例男性和548例女性）因肺栓塞接受CTA-CTV检查。报告评估如下：肺栓塞阳性或阴性，伴或不伴深静脉血栓形成（DVT）或CTV检查结果未明确诊断。存在恶性肿瘤、既往静脉血栓栓塞症（VTE）、近期手术及心血管疾病等并存因素的446例患者组成高危组。其余383例患者组成低危组。统计分析包括四个二元预测因素（既往VTE、恶性肿瘤、心血管疾病和手术）和三个二元结果变量（肺栓塞、DVT和VTE）。进行了卡方检验、单因素和多因素回归分析。

结果

829例患者中，VTE、肺栓塞和DVT的发生率分别为152例（18.3%）、124例（15.0%）和61例（7.3%）。高危组和低危组中，VTE的患病率分别为446例中的114例（25.6%）和383例中的38例（9.9%）（p<0.001）；肺栓塞的患病率分别为446例中的92例（20.6%）和383例中的32例（8.3%）（p<0.001）。829例患者中发现孤立性DVT 28例（3.4%）。整个队列中CTV的增加值为3.4%，低危组为0.72%（829例中的6例），高危组为2.6%（829例中的22例）。对于结果变量VTE，恶性肿瘤和既往VTE具有统计学意义（分别为p = 0.04和p<0.001）；对于肺栓塞，恶性肿瘤和既往VTE具有统计学意义（分别为p = 0.03和p = 0.005）；对于DVT，只有既往VTE具有统计学意义（p<0.001）。