Okada Munemasa, Kunihiro Yoshie, Nakashima Yoshiteru, Nomura Takafumi, Kudomi Shohei, Yonezawa Teppei, Suga Kazuyoshi, Matsunaga Naofumi
Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan.
Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan.
Eur J Radiol. 2015 Jan;84(1):172-177. doi: 10.1016/j.ejrad.2014.09.009. Epub 2014 Sep 28.
To investigate the added value of lung perfused blood volume (LPBV) using dual-energy CT for the evaluation of intrapulmonary clot (IPC) in patients suspected of having acute pulmonary embolism (PE).
Institutional review board approval was obtained for this retrospective study. Eighty-three patients suspected of having PE who underwent CT pulmonary angiography (CTPA) using a dual-energy technique were enrolled in this study. Two radiologists who were blinded retrospectively and independently reviewed CTPA images alone and the combined images with color-coded LPBV over a 4-week interval, and two separate sessions were performed with a one-month interval. Inter- and intraobserver variability and diagnostic accuracy were evaluated for each reviewer with receiver operating characteristic (ROC) curve analysis.
Values for inter- and intraobserver agreement, respectively, were better for CTPA combined with LPBV (ICC=0.847 and 0.937) than CTPA alone (ICC=0.748 and 0.861). For both readers, diagnostic accuracy (area under the ROC curve [Az]) were also superior, when CTPA alone (Az=0.888 [reader 1] and 0.912 [reader 2]) was compared with that after the combination with LPBV images (Az=0.966 [reader 1] and 0.959 [reader 2]) (p<0.001). However, Az values of both images might not have significant difference in statistics, because Az value of CTPA alone was high and 95% confidence intervals overlapped in both images.
Addition of dual-energy perfusion CT to CTPA improves detection of peripheral IPCs with better interobserver agreement.
探讨双能CT测量肺灌注血容量（LPBV）在疑似急性肺栓塞（PE）患者肺内血栓（IPC）评估中的附加价值。
本回顾性研究获得了机构审查委员会的批准。83例疑似PE且接受双能CT肺动脉造影（CTPA）的患者纳入本研究。两名放射科医生在4周的时间间隔内对仅CTPA图像以及结合了彩色编码LPBV的图像进行回顾性独立盲法评估，且在1个月的间隔内进行了两次独立评估。通过受试者操作特征（ROC）曲线分析评估每位观察者的组间和组内变异性以及诊断准确性。
与单独的CTPA（组内相关系数[ICC]=0.748和0.861）相比，CTPA结合LPBV时观察者间和观察者内的一致性值分别更好（ICC=0.847和0.937）。对于两位阅片者，与单独CTPA（Az=0.888[阅片者1]和0.912[阅片者2]）相比，CTPA结合LPBV图像后的诊断准确性（ROC曲线下面积[Az]）也更高（Az=0.966[阅片者1]和0.959[阅片者2]）（p<0.001）。然而，由于单独CTPA的Az值较高且两者图像的95%置信区间重叠，两种图像的Az值在统计学上可能没有显著差异。
CTPA联合双能灌注CT可提高外周IPC的检测率，且观察者间一致性更好。
