CT 血管造影中漏诊的肺栓塞：应用肺栓塞-计算机辅助检测评估。

Missed pulmonary emboli on CT angiography: assessment with pulmonary embolism-computer-aided detection.

机构信息

1 All authors: Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201.

出版信息

AJR Am J Roentgenol. 2014 Jan;202(1):65-73. doi: 10.2214/AJR.13.11049.

DOI:10.2214/AJR.13.11049

PMID:24370130

Abstract

OBJECTIVE

The purpose of this study is to assess the use of a pulmonary embolism (PE)- computer-aided detection (CADx) program in the detection of PE missed in clinical practice.

MATERIALS AND METHODS

Pulmonary CT angiography (CTA) studies (n = 6769) performed between January 2009 and July 2012 were retrospectively assessed by a thoracic radiologist. In studies that were positive for PE, all prior contrast-enhanced pulmonary CTA studies were reviewed. Missed PE was deemed to have occurred if PE was not described in the final interpretation. The presence, proximal extent, and number of PEs were agreed on by three thoracic radiologists. Studies with missed acute PE and available slice thickness of 2 mm or less were assessed with a prototype PE-CADx program. False-positive PE-CADx marks were analyzed. Outcomes of missed acute PEs were assessed in patients with both follow-up imaging and clinical data.

RESULTS

Fifty-three studies with overlooked acute PE met our inclusion criteria for PE-CADx assessment. The PE-CADx program identified at least one PE in 77.4% of instances (41/53). PE-CADx correctly marked at least one PE in 23 of 23 cases (100%) with multiple PEs and 18 of 30 (60%) cases with a solitary PE (p < 0.001). PE-CADx per-study sensitivity was significantly higher for segmental (65.5%) than for subsegmental (91.7%) PEs (p = 0.002). PE-CADx averaged 3.8 false-positive marks per case (range, 0-23 marks). Fourteen patients with missed PE who were not receiving anticoagulation therapy developed new PEs, including nine with an isolated subsegmental PE on the initial CT scan.

CONCLUSION

PE-CADx correctly identified 77.4% of cases of acute PE that were previously missed in clinical practice.

摘要

目的

本研究旨在评估肺栓塞（PE）-计算机辅助检测（CADx）程序在检测临床漏诊的 PE 中的应用。

材料与方法

回顾性分析 2009 年 1 月至 2012 年 7 月期间进行的肺 CT 血管造影（CTA）研究（n=6769），由胸放射科医生进行评估。在 PE 阳性的研究中，回顾了所有先前的对比增强肺 CTA 研究。如果最终的解读中未描述 PE，则认为存在漏诊的 PE。三位胸放射科医生对存在、近端范围和数量的 PE 达成一致。对有遗漏的急性 PE 和可获得 2 毫米或以下切片厚度的研究进行了原型 PE-CADx 程序评估。分析了假阳性的 PE-CADx 标记。对具有随访影像学和临床数据的漏诊急性 PE 患者的结局进行了评估。

结果

53 项具有被忽视的急性 PE 的研究符合我们对 PE-CADx 评估的纳入标准。PE-CADx 程序在 77.4%（41/53）的情况下至少识别出一个 PE。PE-CADx 在 23 例有多个 PE 的病例（100%）和 30 例有孤立性 PE 的病例（60%）中至少正确标记出一个 PE（p<0.001）。PE-CADx 的每例研究敏感性，在节段性（65.5%）PE 中显著高于亚节段性（91.7%）PE（p=0.002）。PE-CADx 平均每个病例有 3.8 个假阳性标记（范围 0-23 个标记）。14 例未接受抗凝治疗的漏诊 PE 患者发生了新的 PE，其中 9 例在初始 CT 扫描时有孤立性亚节段性 PE。