Albert Einstein College of Medicine, Bronx, New York
Montefiore Medical Center, Bronx, New York; and.
J Nucl Med. 2021 Mar;62(3):399-404. doi: 10.2967/jnumed.120.242776. Epub 2020 Jul 17.
Asthma and pulmonary embolism (PE) can present with overlapping symptoms, and distinguishing between these 2 conditions can be challenging. Asthma may limit imaging for PE because of either worsened ventilation defects on ventilation-perfusion scanning (VQ) or increased motion artifacts on CT pulmonary angiography (CTPA). We identified adults evaluated for PE with VQ or CTPA from 2012 to 2016. Patients with chronic lung disease (other than asthma) were excluded. Studies were classified as negative, positive, or nondiagnostic. Follow-up of negative cases was reviewed to determine the rate of repeat exams (within 1 wk) and the false-negative rate (defined as diagnosis of venous thromboembolism within 90 d). We reviewed 19,412 adults (aged 52 ± 18 y, 70% women) evaluated for PE (60% with VQ, 40% with CTPA); 23% had a history of asthma. Nondiagnostic results were comparable for those with and without asthma for both VQ (asthma, 3.3%; nonasthma, 3.8%; = 0.223) and CTPA (asthma, 1.6%; nonasthma, 1.5%; = 0.891). A history of asthma was not associated with a higher rate of repeat exams after negative imaging for VQ (asthma, 1.9%; nonasthma, 2.1%; = 0.547) or CTPA (asthma, 0.6%; nonasthma, 0.6%; = 0.796), nor was a history of asthma associated with a higher false-negative rate for VQ (asthma, 0.4%; nonasthma, 0.9%; = 0.015) or CTPA (asthma, 1.9%; nonasthma 1.5%; = 0.347). A history of asthma in the preceding 10 y was not associated with impaired diagnostic performance of PE imaging for either VQ or CTPA.
哮喘和肺栓塞（PE）可能有重叠的症状，区分这两种情况具有挑战性。哮喘可能会由于通气灌注扫描（VQ）上通气缺陷恶化或 CT 肺动脉造影（CTPA）上运动伪影增加而限制对 PE 的成像。我们从 2012 年到 2016 年确定了接受 VQ 或 CTPA 评估的成年人的 PE。排除了患有慢性肺部疾病（非哮喘）的患者。将研究分为阴性、阳性和非诊断性。对阴性病例的随访进行了审查，以确定重复检查的比例（在 1 周内）和假阴性率（定义为在 90 天内诊断为静脉血栓栓塞症）。我们审查了 19412 名接受 PE 评估的成年人（年龄 52 ± 18 岁，70%为女性）；其中 23%有哮喘病史。VQ 和 CTPA 中，有无哮喘的非诊断结果相似（VQ：哮喘，3.3%；非哮喘，3.8%；= 0.223）和 CTPA（哮喘，1.6%；非哮喘，1.5%；= 0.891）。在 VQ 阴性成像后，有哮喘病史与重复检查率升高无关（VQ：哮喘，1.9%；非哮喘，2.1%；= 0.547）或 CTPA（哮喘，0.6%；非哮喘，0.6%；= 0.796），也与 VQ（哮喘，0.4%；非哮喘，0.9%；= 0.015）或 CTPA（哮喘，1.9%；非哮喘，1.5%；= 0.347）的假阴性率升高无关。在过去 10 年中有哮喘病史与 VQ 或 CTPA 对 PE 成像的诊断性能受损无关。
