Department of Radiology, UUCSD, San Diego, CA.
Emory University, Atlanta, GA.
J Thorac Imaging. 2018 Nov;33(6):350-357. doi: 10.1097/RTI.0000000000000361.
This study aimed to assess the factors contributing toward accurate detection and erroneous interpretation of pulmonary embolism (PE).
Over 13 months, all computed tomography pulmonary angiography studies were retrospectively rereviewed by a chest radiologist. Two additional chest radiologists assessed cases with disagreement between the first interpretation and rereview. The number, extent, and location of PE and specialty training, experience, time of study, kV, resident prelim, use of iterative reconstruction, signal to noise ratio (SNR), and reports describing the study as "limited" were recorded. Parametric and nonparametric statistical testing was performed (significance P<0.05).
Of 2555 computed tomography pulmonary angiography cases assessed, there were 230 true positive (170 multiple, 60 single PE), 2271 true negative, 35 false-negative (15 multiple and 20 single PE), and 19 false-positive studies. The overall sensitivity, specificity, positive predictive value, negative predictive value and accuracy of radiologists was 86.8%, 99.2%, 92.4%, 98.5%, and 97.9%. Sensitivity for the detection of multiple and central PE was significantly higher than the detection of single and peripheral PE, respectively (P<0.01 for both). The sensitivity of thoracic radiologists (91.7%) was higher than nonthoracic (82.8%) and reached significance for single PE (89.2% vs. 61.4%, P<0.02). Errors were more likely in cases with lower SNR (P=0.04) and those described as limited (P<0.001). Misses occurred more frequently in the upper lobe posterior and lower lobe lateral segments and subsegments (P=0.038).
The accuracy for PE detection is high, but errors are more likely in studies with single PE interpreted by nonthoracic radiologists, especially when located in certain segments and in cases with low SNR or described as limited.
本研究旨在评估导致肺栓塞（PE）准确检测和错误解读的因素。
在 13 个月的时间里，由一名胸部放射科医生对所有 CT 肺动脉造影研究进行回顾性重新评估。如果第一次解读与重新评估之间存在分歧，另外两名胸部放射科医生将对这些病例进行评估。记录 PE 的数量、范围和位置、专业培训、经验、研究时间、kV、住院医师初步评估、使用迭代重建、信噪比（SNR）以及描述研究为“有限”的报告。进行了参数和非参数统计检验（显著性 P<0.05）。
在评估的 2555 例 CT 肺动脉造影病例中，有 230 例为真阳性（170 例为多发，60 例为单发 PE），2271 例为真阴性，35 例为假阴性（15 例为多发，20 例为单发 PE），19 例为假阳性研究。放射科医生的总体敏感性、特异性、阳性预测值、阴性预测值和准确性分别为 86.8%、99.2%、92.4%、98.5%和 97.9%。多发和中央型 PE 的检测敏感性明显高于单发和外周型 PE，分别有显著性差异（均为 P<0.01）。胸部放射科医生（91.7%）的敏感性高于非胸部放射科医生（82.8%），单发 PE 尤其显著（89.2%比 61.4%，P<0.02）。SNR 较低（P=0.04）和描述为“有限”的病例（P<0.001）更容易出错。上叶后段和下叶外侧段和亚段更常出现漏诊（P=0.038）。
PE 的检测准确性很高，但由非胸部放射科医生解读的单发 PE 研究、尤其是位于特定节段且 SNR 较低或描述为“有限”的病例更容易出错。
