Bélanger Chantale, Chartrand-Lefebvre Carl, Soulez Gilles, Faughnan Marie E, Tahir Muhammad Ramzan, Giroux Marie-France, Gilbert Patrick, Perreault Pierre, Bouchard Louis, Oliva Vincent L, Therasse Eric
Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada.
Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada; Centre de recherche, Centre hospitalier de l'Université de Montreal (CRCHUM), Montreal, QC, Canada.
Eur J Radiol. 2016 Jan;85(1):150-157. doi: 10.1016/j.ejrad.2015.11.014. Epub 2015 Nov 10.
To evaluate the sensitivity and specificity of non-enhanced chest CT to detect reperfusion after pulmonary arteriovenous malformation (PAVM) embolization.
The Institutional Review Board approved this retrospective HIPAA-compliant study and waived the need for patient consent. All consecutive patients who underwent PAVM embolization between January 2000 and April 2011 were included. Complex PAVMs and patients without available pre- and/or post-embolization CT were excluded. PAVM artery, aneurysm and vein diameters were measured on non-enhanced chest CT before and after PAVM embolization. Pulmonary angiography (PA) was the reference standard to assess PAVM reperfusion. Reperfusion detection was analyzed with receiver operating characteristic (ROC) curves according to percentage of diameter reduction cut-off. Inter-observer concordance was ascertained with intra-class correlation coefficients (ICCs).
Out of 68 patients with PAVM embolizations, 42 (62%) had 108 PAVMs that met inclusion/exclusion criteria. Areas under the ROC curves for PAVM reperfusion detection were 0.84, 0.87, and 0.78, respectively, for PAVM artery, aneurysm and vein (p>0.05). Sensitivity varied between 51% and 56%, and specificity between 86% and 98% for the <30% diameter reduction cut-off. Sensitivity was between 98% and 100%, and specificity, between 20% and 47% for the <70% diameter reduction cut-off. ICCs for inter-observer concordance were 0.58, 0.88 and 0.68 for percentage reduction of PAVM artery, aneurysm and vein, respectively.
PAVM diameter reduction cut-offs of <30% and <70%, to detect PAVM reperfusion on non-enhanced CT reported in the literature, would respectively result in low sensitivity and specificity.
评估非增强胸部CT检测肺动静脉畸形（PAVM）栓塞后再灌注的敏感性和特异性。
机构审查委员会批准了这项符合HIPAA的回顾性研究，并免除了患者知情同意的要求。纳入2000年1月至2011年4月期间所有连续接受PAVM栓塞治疗的患者。排除复杂PAVM以及没有栓塞前和/或栓塞后CT资料的患者。在PAVM栓塞前后的非增强胸部CT上测量PAVM的动脉、瘤体和静脉直径。肺血管造影（PA）是评估PAVM再灌注的参考标准。根据直径缩小截断百分比，采用受试者操作特征（ROC）曲线分析再灌注检测情况。通过组内相关系数（ICC）确定观察者间的一致性。
在68例接受PAVM栓塞治疗的患者中，42例（62%）有108个PAVM符合纳入/排除标准。PAVM动脉、瘤体和静脉再灌注检测的ROC曲线下面积分别为0.84、0.87和0.78（p>0.05）。对于直径缩小<30%的截断值，敏感性在51%至56%之间，特异性在86%至98%之间。对于直径缩小<70%的截断值，敏感性在98%至100%之间，特异性在20%至47%之间。PAVM动脉、瘤体和静脉直径缩小百分比的观察者间一致性ICC分别为0.58、0.88和0.68。
文献报道的用于在非增强CT上检测PAVM再灌注的直径缩小截断值<30%和<70%，分别会导致低敏感性和低特异性。
