Jones Christian, Teixeira Pedro G R, Inaba Kenji, Keesara Sravanthi R, Rhee Peter, Brown Carlos, Salim Ali, Browder Timothy, Demetriades Demetrios
Division of Trauma and Critical Care, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA.
Am Surg. 2008 Oct;74(10):935-8.
CT Venography (CTV) performed at the time of CT pulmonary angiography (CTPA) images the central, pelvic, and extremity venous circulation with minimal additional time, radiation, and no added contrast. CTV has been added to CTPA routinely at our Level I trauma center since 2000, and we sought to determine if this addition had increased the diagnostic yield of CTPA in trauma patients. The attending radiologist's interpretation of all CTPA-CTV studies performed over a 5-year period ending in August 2006 were retrospectively reviewed. CTPAs and CTVs were categorized as "positive", "negative", or "indeterminate" for pulmonary embolus (PE) and deep venous thrombosis (DVT). During the study period, 3798 patients underwent both a CTPA and CTV; 309 (8%) of these were trauma patients. Forty-four (14%) had a PE diagnosed on CTPA. Seventeen (6%) had a DVT diagnosed on CTV. In eight (3%), the CTV added clinically relevant data, diagnosing a DVT in a patient without PE. As the consequences of a missed pelvic DVT are high and the added time burden, radiation, and contrast required for a CTV are low, further investigation into optimizing the sensitivity of CTV performed at the time of CTPA is warranted.
在进行CT肺动脉造影（CTPA）时同步进行的CT静脉造影（CTV），能够在几乎不增加额外时间、辐射剂量且无需额外注射造影剂的情况下，对中心、盆腔及四肢静脉循环进行成像。自2000年起，在我们的一级创伤中心，CTV已被常规添加到CTPA检查中，我们试图确定这种添加是否提高了CTPA对创伤患者的诊断率。对截至2006年8月的5年期间内所有进行的CTPA-CTV检查结果，由主治放射科医生进行回顾性分析。CTPA和CTV对于肺栓塞（PE）和深静脉血栓形成（DVT）的诊断结果被分类为“阳性”、“阴性”或“不确定”。在研究期间，3798例患者同时接受了CTPA和CTV检查；其中309例（8%）为创伤患者。44例（14%）在CTPA检查中被诊断为PE。17例（6%）在CTV检查中被诊断为DVT。在8例（3%）患者中，CTV提供了具有临床相关性的数据，诊断出了无PE的患者存在DVT。鉴于漏诊盆腔DVT的后果严重，而CTV所需的额外时间、辐射剂量和造影剂用量较低，因此有必要进一步研究如何优化在CTPA检查时进行的CTV的敏感性。
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