Kong Wei-Fang, Wang Yu-Ting, Yin Long-Lin, Pu Hong, Tao Ke-Yan
Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, No. 32, Section 2, 1st Ring Road (West), Chengdu, 610072, Sichuan Province, China.
Int J Cardiovasc Imaging. 2017 Dec;33(12):2039-2047. doi: 10.1007/s10554-017-1188-x. Epub 2017 Jun 13.
To compare the ability of CT angiography (CTA) obstruction score and perfusion defect score on dual energy CT perfusion imaging (DEPI) for clinical risk stratification of patients with acute pulmonary embolism (PE). 55 patients diagnosed as acute PE either by CTA or DEPI were retrospectively enrolled. Patients were grouped into high-, intermediate-, and low-risk groups in accordance to the renewed guidelines of 2014. Consistency between DEPI and CTA in diagnosis of PE were assessed. Correlations between CT parameters and right-to-left ventricular (RV/LV) diameter ratio were evaluated. Difference of CTA obstruction score and perfusion defect score across three groups with different risks were analyzed. The consistent rate of DEPI with CTA was 75.4%, and the Kappa value was 0.412 (p = 0.000). 44.3% of partially obstructive PE showed on CTA did not lead to perfusion defect on DEPI. Perfusion defect score was significantly correlated with CTA obstruction score and with RV/LV (r = 0.622 and 0.599, respectively, p < 0.001), and CTA obstruction score had lower correlation with RV/LV (r = 0.403, p = 0.003). Perfusion defect score could distinguish low- from intermediate-risk groups (p = 0.011). However, CTA obstruction score could not distinguish the two groups (p = 0.149). DEPI had fine consistency with CTA to diagnose acute PE and offered additional information of physiologic changes. Comparing with CTA obstruction score, perfusion defect score could better correlate with right ventricular dysfunction, and could be a more promising biomarker for clinical risk stratification.
比较CT血管造影（CTA）梗阻评分和双能CT灌注成像（DEPI）上的灌注缺损评分在急性肺栓塞（PE）患者临床风险分层中的能力。回顾性纳入55例经CTA或DEPI诊断为急性PE的患者。根据2014年更新的指南将患者分为高、中、低风险组。评估DEPI和CTA在PE诊断中的一致性。评估CT参数与右心室/左心室（RV/LV）直径比之间的相关性。分析三组不同风险中CTA梗阻评分和灌注缺损评分的差异。DEPI与CTA的一致率为75.4%，Kappa值为0.412（p = 0.000）。CTA显示的部分阻塞性PE中有44.3%在DEPI上未导致灌注缺损。灌注缺损评分与CTA梗阻评分以及与RV/LV显著相关（r分别为0.622和0.599，p < 0.001），而CTA梗阻评分与RV/LV的相关性较低（r = 0.403，p = 0.003）。灌注缺损评分可以区分低风险组和中风险组（p = 0.011）。然而，CTA梗阻评分无法区分这两组（p = 0.149）。DEPI在诊断急性PE方面与CTA具有良好的一致性，并提供了生理变化的额外信息。与CTA梗阻评分相比，灌注缺损评分与右心室功能障碍的相关性更好，可能是一种更有前景的临床风险分层生物标志物。
