Radiology Department, University Hospital, Brest, France.
EA 3878 GETBO IFR 148, Brest, France.
Eur Radiol. 2020 Sep;30(9):4857-4864. doi: 10.1007/s00330-020-06836-3. Epub 2020 Apr 11.
To assess the diagnostic accuracy of iodine map computed tomography pulmonary angiography (CTPA), for segment-based evaluation of lung perfusion in patients with acute pulmonary embolism (PE), using perfusion single-photon emission CT (SPECT) imaging as a reference standard.
Thirty participants who have been diagnosed with acute pulmonary embolism on CTPA underwent perfusion SPECT/CT within 24 h. Perfusion SPECT and iodine map were independently interpreted by 2 nuclear medicine physicians and 2 radiologists. For both modalities, each segment was classified as normoperfused or hypoperfused, as defined by a perfusion defect of more than 25% of a segment. The primary end point was the diagnostic accuracy (sensitivity and specificity) of iodine map for segment-based evaluation of lung perfusion, using perfusion SPECT imaging as a reference standard. Following blinded interpretation, a retrospective explanatory analysis was performed to determine potential causes of misinterpretation.
The median time between CTPA with iodine maps and perfusion SPECT was 14 h (range 2-23 h). A total of 597 segments were analyzed. Sensitivity and specificity of iodine maps with CTPA for the detection of segmental perfusion defects were 231/284 = 81.3% (95% CI 76.4 to 85.4%) and 247/313 = 78.9% (95% CI 74.1 to 83.1%), respectively. In retrospect, false results were explained in 48.7%.
Iodine map CTPA showed promising results for the assessment of pulmonary perfusion in patients with acute PE, with sensitivity of 81.3% and specificity of 78.9%, respectively. Recognition of typical pitfalls such as atelectasis, fissures, or beam-hardening artifacts may further improve the accuracy of the test.
• Sensitivity and specificity of iodine subtraction maps for the detection of segmental perfusion defects were 81.3% (95% CI 76.4 to 85.4%) and 78.9% (95% CI 74.1 to 83.1%), respectively. • Recognition of typical pitfalls such as atelectasis, fissures, or beam-hardening artifacts may further improve the diagnostic accuracy of the test.
通过灌注单光子发射 CT（SPECT）成像作为参考标准，评估碘图计算机断层肺动脉造影（CTPA）在急性肺栓塞（PE）患者以节段为基础的肺灌注评估中的诊断准确性。
30 名在 CTPA 上诊断为急性肺栓塞的患者在 24 小时内接受了灌注 SPECT/CT 检查。灌注 SPECT 和碘图由 2 名核医学医师和 2 名放射科医师独立进行解读。对于这两种模式，每个节段都被分类为正常灌注或低灌注，灌注缺损超过节段的 25%定义为灌注缺损。主要终点是碘图在以节段为基础的肺灌注评估中的诊断准确性（敏感性和特异性），以灌注 SPECT 成像作为参考标准。在盲法解读后，进行了回顾性解释性分析，以确定可能导致误读的潜在原因。
CTPA 与碘图之间的中位时间为 14 小时（范围为 2-23 小时）。共分析了 597 个节段。CTPA 碘图检测节段性灌注缺损的敏感性和特异性分别为 231/284=81.3%（95%CI 76.4-85.4%）和 247/313=78.9%（95%CI 74.1-83.1%）。回顾性分析中，48.7%的结果可以解释。
碘图 CTPA 对急性 PE 患者的肺灌注评估显示出有前景的结果，敏感性为 81.3%，特异性为 78.9%。识别典型的陷阱，如肺不张、裂隙或束硬化伪影，可能进一步提高测试的准确性。
碘图检测节段性灌注缺损的敏感性和特异性分别为 81.3%（95%CI 76.4-85.4%）和 78.9%（95%CI 74.1-83.1%）。
识别典型的陷阱，如肺不张、裂隙或束硬化伪影，可能进一步提高测试的准确性。
