1 Department of Medicine, and.
Ann Am Thorac Soc. 2015 May;12(5):689-95. doi: 10.1513/AnnalsATS.201404-144OC.
To investigate how often computed tomography (CT) pulmonary angiography contributes to establishing a diagnosis in patients presenting to the emergency department and how it performs compared to chest radiograph.
The objective of this study was to measure the ability to identify a diagnosis and to investigate the prevalence and significance of incidental findings in patients evaluated with computed tomography pulmonary angiography in the emergency department.
All adult patients evaluated with CT angiography over a 2-year period (January 1, 2011 to December 31, 2012) were included in the analysis. A total of 641 records were identified. Chest radiographs and CT angiography reports were reviewed to determine whether they could provide a diagnosis in patients without pulmonary embolism (PE). Studies negative for PE were stratified into three categories according to significance: type I prompted immediate action, type II required follow up, and type III had findings of limited significance.
CT angiography identified a diagnosis in 22.46% of the patient population and in 14.31% of patients without PE. In patients who had CT angiography with chest radiograph, diagnoses were provided in 14.01 and 9.86% of patients, respectively. When analysis was isolated to patients with low probability for PE, CT angiography provided a diagnosis in 20% and chest radiography in 10.23% of patients. The majority of missed cases represented infiltrates too small to be detected by radiography and were believed to represent lung infections by the interpreting radiologist. Among studies negative for PE, 15% were type I, 17.07% were type II, 48.1% were type III, and the rest were normal.
CT angiography is superior to chest radiography at providing a diagnosis in patients investigated for PE, even when no PE is present. However, in patients at low risk for PE, the clinical benefit of the additional diagnoses is questionable.
为了研究计算机断层扫描（CT）肺动脉造影在急诊就诊患者中建立诊断的频率，以及与胸部 X 线摄影相比的表现。
本研究的目的是测量识别诊断的能力，并研究在急诊科接受 CT 肺动脉造影评估的患者中偶然发现的患病率和意义。
分析了在 2 年期间（2011 年 1 月 1 日至 2012 年 12 月 31 日）接受 CT 血管造影的所有成年患者。共确定了 641 例记录。回顾了胸部 X 线摄影和 CT 血管造影报告，以确定它们是否可以为没有肺栓塞（PE）的患者提供诊断。根据意义，将阴性的 PE 研究分为三类：I 型提示立即采取行动，II 型需要随访，III 型有有限意义的发现。
CT 血管造影在 22.46%的患者人群和 14.31%无 PE 的患者中确定了诊断。在进行 CT 血管造影和胸部 X 线摄影的患者中，分别有 14.01%和 9.86%的患者做出了诊断。当分析仅限于低概率 PE 的患者时，CT 血管造影在 20%的患者和胸部 X 线摄影在 10.23%的患者中提供了诊断。大多数漏诊病例代表太小而无法通过 X 射线检测到的浸润，并且被解释放射科医生认为是肺部感染。在阴性的 PE 研究中，15%为 I 型，17.07%为 II 型，48.1%为 III 型，其余为正常。
即使在没有 PE 的情况下，CT 血管造影在为 PE 患者提供诊断方面也优于胸部 X 线摄影。但是，在低风险的 PE 患者中，额外诊断的临床益处值得怀疑。
