在急诊科头晕的影像学评估中，常规头颈部 CT 血管造影的作用有限。
Limited usefulness of routine head and neck CT angiogram in the imaging assessment of dizziness in the emergency department.
机构信息
Department of Radiology, University of Ottawa, The Ottawa Hospital, Canada.
Department of Medicine, Division of Neurology, University of Ottawa, The Ottawa Hospital, Canada.
出版信息
Neuroradiol J. 2021 Aug;34(4):335-340. doi: 10.1177/1971400920988665. Epub 2021 Jan 25.
OBJECTIVE
To assess the usefulness of head and neck computed tomography angiogram for the investigation of isolated dizziness in the emergency department in detecting significant acute findings leading to a change in management in comparison to non-contrast computed tomography scan of the head.
METHODS
Patients presenting with isolated dizziness in the emergency department investigated with non-contrast computed tomography and computed tomography angiogram over the span of 36 months were included. Findings on non-contrast computed tomography were classified as related to the emergency department presentation versus unrelated/no significant abnormality. Similarly, computed tomography angiogram scans were classified as positive or negative posterior circulation findings.
RESULTS
One hundred and fifty-three patients were imaged as a result of emergency department presentation with isolated dizziness. Fourteen cases were diagnosed clinically as of central aetiology. Non-contrast computed tomography was positive in three patients, all with central causes with sensitivity 21.4%, specificity 100%, positive predictive value 100%, negative predictive value 92.6% and accuracy 92.8%. Computed tomography angiogram was positive for angiographic posterior circulation abnormalities in five cases, and only two of them had a central cause of dizziness, with sensitivity 14.3%, specificity 97.7%, positive predictive value 40%, negative predictive value 91.46% and accuracy 92.1%.
CONCLUSION
Both non-contrast computed tomography and computed tomography angiogram of the head and neck have low diagnostic yield for the detection of central causes of dizziness, However, non-contrast computed tomography has higher sensitivity and positive predictive value than computed tomography angiogram, implying a lack of diagnostic advantage from the routine use of computed tomography angiogram in the emergency department for the investigation of isolated dizziness. Further studies are required to determine the role of computed tomography angiogram in the work-up of isolated dizziness in the emergency department.
目的
评估头颈部 CT 血管造影在急诊科检查孤立性头晕中的作用，与头部非增强 CT 扫描相比，该检查在检测导致治疗方式改变的显著急性发现方面的作用。
方法
纳入了在 36 个月内因孤立性头晕在急诊科接受非增强 CT 和 CT 血管造影检查的患者。非增强 CT 的发现分为与急诊科表现相关和不相关/无显著异常。同样，将 CT 血管造影扫描分为阳性或阴性后循环发现。
结果
由于急诊科孤立性头晕就诊，共对 153 例患者进行了影像学检查。14 例患者临床诊断为中枢性病因。3 例患者的非增强 CT 呈阳性，均为中枢性病因，敏感性为 21.4%，特异性为 100%，阳性预测值为 100%，阴性预测值为 92.6%，准确性为 92.8%。CT 血管造影对 5 例后循环血管异常呈阳性，其中仅 2 例为头晕的中枢性病因，敏感性为 14.3%，特异性为 97.7%，阳性预测值为 40%，阴性预测值为 91.46%，准确性为 92.1%。
结论
头颈部非增强 CT 和 CT 血管造影对检测头晕的中枢性病因的诊断率均较低。然而，非增强 CT 的敏感性和阳性预测值均高于 CT 血管造影，这意味着在急诊科常规使用 CT 血管造影检查孤立性头晕并无诊断优势。需要进一步研究来确定 CT 血管造影在急诊科孤立性头晕检查中的作用。
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