胸部 CT 血管造影在疑似肺栓塞患者中的诊断率：独立预测因素和方案依从性。
Diagnostic yield of CT thorax angiography in patients suspected of pulmonary embolism: independent predictors and protocol adherence.
机构信息
Department of Pulmonology, Isala, Dr. van Heesweg 2, 8025 AB, Zwolle, The Netherlands,
出版信息
Insights Imaging. 2014 Apr;5(2):231-6. doi: 10.1007/s13244-014-0325-5. Epub 2014 Apr 3.
OBJECTIVES
To determine the diagnostic yield of computed tomography scanning of the pulmonary arteries (CTPA) in our centre and factors associated with it. Differences between specialties as well as adherence to protocol were investigated.
METHODS
All patients receiving a first CTPA for pulmonary embolism (PE) in 2010 were included. Data about relevant clinical information and the requesting specialty were retrospectively obtained. Differences in diagnostic yield were tested using a chi-squared test. Independent predictors were identified with multivariate logistic regression.
RESULTS
PE on CTPA was found in 224 of the 974 patients (23 %). Between specialties, diagnostic yield varied from 19.5 to 23.9 % (p = 0.20). Independent predictors of diagnostic yield were: age, sex, D-dimer, cough, dyspnea, cardiac history, chronic obstructive pulmonary disease (COPD), atelectasis/consolidation, intrapulmonary mass and/or interstitial pulmonary disease on CT. Wells scores were poorly documented (n = 127, 13.0 %). Poor adherence to protocol was also shown by a high amount of unnecessary D-dimer values with a high Wells-score (35 of 58; 58.6 %).
CONCLUSIONS
The diagnostic yield of CTPA in this study was relatively high in comparison with other studies (6.7-31 %). Better adherence to protocol might improve the diagnostic yield further. A prospective study could confirm the independent predictors found in this study.
TEACHING POINTS
• Pulmonary embolism is potentially life-threatening and requires quick and reliable diagnosis. • Computed tomography of the pulmonary arteries (CTPA) provides this reliable diagnosis. • Several independent predictors of diagnostic yield of CTPA for pulmonary embolism were identified. • Diagnostic yield of CTPA did not differ between requesting specialties in our Hospital. • Better protocol adherence could improve the diagnostic yield of CTPA for pulmonary embolism.
目的
确定我们中心肺动脉计算机断层扫描（CTPA）的诊断收益及其相关因素。研究了不同专业之间的差异以及对方案的遵守情况。
方法
纳入 2010 年首次因肺栓塞（PE）接受 CTPA 的所有患者。回顾性获得有关临床信息和请求专业的资料。使用卡方检验测试诊断收益的差异。使用多变量逻辑回归确定独立预测因子。
结果
在 974 例患者中，有 224 例（23%）在 CTPA 上发现了 PE。不同专业之间，诊断收益从 19.5%到 23.9%不等（p=0.20）。诊断收益的独立预测因子是：年龄、性别、D-二聚体、咳嗽、呼吸困难、心脏病史、慢性阻塞性肺疾病（COPD）、肺不张/实变、肺内肿块和/或间质性肺疾病。Wells 评分记录不佳（n=127，13.0%）。高 Wells 评分时不必要的 D-二聚体值数量较多，也表明对方案的遵守程度较差（35/58；58.6%）。
结论
与其他研究（6.7-31%）相比，本研究中 CTPA 的诊断收益相对较高。更好地遵守方案可能会进一步提高诊断收益。前瞻性研究可以证实本研究中发现的独立预测因子。
教学要点
• 肺栓塞具有潜在的致命性，需要快速可靠的诊断。
• 肺动脉计算机断层扫描（CTPA）提供了这种可靠的诊断。
• 确定了几个与 CTPA 诊断肺栓塞的诊断收益相关的独立预测因子。
• 我们医院不同请求专业之间 CTPA 的诊断收益没有差异。
• 更好地遵守方案可以提高 CTPA 诊断肺栓塞的收益。
Zotero 插件