Department of Radiology, Fujian Medical University Union Hospital, No. 29, Xinquan Road, Fuzhou, 350001, China.
School of Medical Technology and Engineering, Fujian Medical University, No. 1 Xue Yuan Road, University Town, Fuzhou, Fujian, 350108, China.
Radiol Med. 2018 Jun;123(6):399-405. doi: 10.1007/s11547-018-0860-0. Epub 2018 Feb 9.
The purpose of this study was to investigate the prevalence of incidental pulmonary embolism (IPE) in suspected stroke patients receiving carotid computed tomography angiography (CTA) and its characteristics.
A total of 4873 cases receiving carotid CTA between January 2013 and December 2016 were retrospectively reassessed by one radiologist. Patients with previous or suspected PE were excluded. The remaining prior contrast-enhanced carotid CTA studies were regarded as a "potentially incidental" IPE when a filling defect was found in one or more pulmonary arteries and subjected to the other two thoracic radiologists independently for reviewing and assessing for characteristics of the IPE and the image quality of the PE. The differences were noted between inpatients and outpatients in prevalence of IPE. Characteristics of the patients with IPE were also studied in terms of gender, age, as well as clinical indication.
The prevalence of IPE among these suspected stroke patients was 0.8% on carotid CT angiography, and 24 (96%) of all IPEs had not been previously diagnosed by the original reporting radiologists. Most of the IPEs were at the lobar or segmental levels, single and in right upper lobe of pulmonary arteries. In most of the cases, the reviewing radiologists judged the contrast bolus as good. The outpatient group had a lower percentage of patients with IPE when compared with the inpatient counterpart (p = 0.024). The prevalence of IPE in patients with suspected stroke was higher with the increasing of age (p = 0.013).
IPE can occur in suspected stroke patients on carotid CT angiography, and most of them have been previously neglected in clinical practice. Radiologists should check the higher pulmonary arterial vasculature carefully on the contrast-enhanced carotid CTA scans.
本研究旨在探讨疑似脑卒中患者接受颈动脉 CT 血管造影（CTA）检查时偶然发现的肺栓塞（IPE）的发生率及其特征。
对 2013 年 1 月至 2016 年 12 月间进行颈动脉 CTA 的 4873 例患者进行了回顾性重新评估。排除有既往或疑似 PE 的患者。当在一条或多条肺动脉中发现充盈缺损时，将其余先前进行的增强颈动脉 CTA 研究视为“可能偶然发生的”IPE，并由另外两名胸部放射科医生独立进行回顾和评估 IPE 的特征和 PE 的图像质量。注意比较门诊和住院患者中 IPE 的发生率差异。还研究了 IPE 患者的性别、年龄以及临床指征等特征。
在疑似脑卒中患者中，颈动脉 CTA 上 IPE 的发生率为 0.8%，所有 IPE 中有 24 例（96%）均未被原始报告放射科医生诊断。大多数 IPE 位于叶段或节段水平，单发且位于肺动脉的右上叶。在大多数情况下，审查放射科医生认为对比剂团注良好。与住院患者相比，门诊患者的 IPE 发生率较低（p=0.024）。疑似脑卒中患者中 IPE 的发生率随年龄的增加而升高（p=0.013）。
IPE 可发生于颈动脉 CTA 检查的疑似脑卒中患者中，且大多数患者在临床实践中被忽视。放射科医生应在增强颈动脉 CTA 扫描时仔细检查肺动脉的较高血管。
