Departments of Radiology, Pompidou Hospital, Université Paris Descartes, 20 rue Leblanc, 75015 Paris, France.
Radiology. 2011 Feb;258(2):590-8. doi: 10.1148/radiol.10100986. Epub 2010 Dec 3.
To evaluate the rate of positive, negative, and indeterminate results and the agreement between initial and expert readings for lung scintigraphy and computed tomographic (CT) angiography performed in patients suspected of having pulmonary embolism (PE) during pregnancy.
Institutional review board approval was obtained. The authors retrospectively analyzed the images from lung scintigraphy and CT angiography performed in pregnant patients during the past 9 years. Images from 46 CT angiographic examinations performed in 43 patients and 91 of 94 lung scintigraphic examinations were reviewed by experts, whose readings were then compared with the initial reports. For CT angiography, the quality of opacification was graded as good, suboptimal, or poor and intraarterial attenuation was measured.
The rates of positive findings (seven of 43 patients [16%] with CT angiography and 10 of 91 patients [11%] with scintigraphy, P = .36), negative findings (28 of 43 patients [65%] with CT angiography and 64 of 91 patients [70%] with scintigraphy, P = .54), and indeterminate findings (eight of 43 patients [19%] with CT angiography and 17 of 91 patients [19%] with scintigraphy, P = .99) were similar for CT angiography and lung scintigraphy. There were four discrepancies between initial and expert readings for CT angiography (κ = 0.84; confidence interval: 0.68, 0.99) and 14 for lung scintigraphy (κ = 0.75; 95% confidence interval: 0.63, 0.87). Opacification was classified as good for only 23 of the 46 CT angiographic examinations (50%). Attenuation values were significantly different among the groups with good, suboptimal, or poor opacification. Alternative diagnoses unsuspected at chest radiography were demonstrated at CT angiography in five of the 43 patients (12%). The mean maternal radiation dose was 0.9 mSv for lung scintigraphy and 7.3 mSv for CT angiography.
Lung scintigraphy and CT angiography have comparable performances for PE diagnosis during pregnancy. Interobserver agreement is better for CT angiography, which also enables alternative diagnosis of unsuspected disease but delivers higher maternal radiation dose.
评估在疑似患有肺栓塞（PE）的孕妇中进行肺部闪烁扫描和计算机断层血管造影（CTA）的阳性、阴性和不确定结果的发生率，以及初始和专家阅读之间的一致性。
获得机构审查委员会批准。作者回顾性分析了过去 9 年中对孕妇进行的肺部闪烁扫描和 CTA 图像。对 43 名患者的 46 次 CTA 检查和 91 次肺部闪烁扫描的图像进行了专家分析，然后将其阅读结果与初始报告进行了比较。对于 CTA，对显影质量进行了分级，分为良好、次优或差，并测量了动脉内衰减。
CTA 的阳性发现率（43 名患者中有 7 例[16%]，91 名患者中有 10 例[11%]，P=.36）、阴性发现率（43 名患者中有 28 例[65%]，91 名患者中有 64 例[70%]，P=.54）和不确定发现率（43 名患者中有 8 例[19%]，91 名患者中有 17 例[19%]，P=.99）与肺部闪烁扫描相似。CTA 有 4 次初始和专家阅读结果不一致（κ=0.84；置信区间：0.68，0.99），肺部闪烁扫描有 14 次不一致（κ=0.75；95%置信区间：0.63，0.87）。46 次 CTA 检查中仅有 23 次显影被分类为良好（50%）。显影质量良好、次优或差的组之间的衰减值存在显著差异。在 43 名患者中的 5 名患者中，在 CTA 上发现了胸部 X 线摄影时未怀疑的其他诊断。肺部闪烁扫描的平均母体辐射剂量为 0.9 mSv，CTA 为 7.3 mSv。
在妊娠期间，肺部闪烁扫描和 CTA 对 PE 的诊断具有相当的性能。CTA 的观察者间一致性更好，并且还能够对未怀疑的疾病进行其他诊断，但会产生更高的母体辐射剂量。
