临床怀疑对急性肠系膜缺血 CT 准确性的影响：362 例患者的回顾性研究。
Influence of clinical suspicion on CT accuracy of acute mesenteric ischemia: Retrospective study of 362 patients.
机构信息
Imagerie médicale, Groupe hospitalier Paris Saint-Joseph, 185 rue Raymond Losserand, 75014, Paris, France.
Unité de recherche clinique, Groupe hospitalier Paris Saint-Joseph, 185 rue Raymond Losserand, 75014, Paris, France.
出版信息
Eur J Radiol. 2021 May;138:109652. doi: 10.1016/j.ejrad.2021.109652. Epub 2021 Mar 11.
PURPOSE
Acute mesenteric ischemia (AMI) may be underdiagnosed when not clinically suspected before CT is performed. We assessed the influence of a clinical suspicion of AMI on the CT accuracy.
METHOD
This retrospective single-centre study included patients who underwent CT in 2014-2019 and had clinically suspected AMI and/or confirmed AMI. CT protocols were adapted based on each patient's presentation and on findings from unenhanced images. The CT protocol was considered optimal for AMI when it included arterial and portal venous phases. CT protocols, accuracy of reports, and outcomes were compared between the groups with and without suspected AMI before CT.
RESULTS
Of the 375 events, 337 (90 %) were suspected AMI and 66 (18 %) were AMI, including 28 (42 %) with and 38 without suspected AMI. These two groups did not differ significantly regarding the medical history, clinical presentation, or laboratory tests. The CT protocol was more often optimal for AMI in the group with suspected AMI (26/28 [93 %] vs. 28/38 [74 %], p = 0.046). Diagnostic accuracy was not different between groups with and without suspected AMI (26/28 [93 %] vs. 34/38 [90 %], p = 1.00). However, it was lower in the group without suspicion of AMI when the CT protocol was not optimal for AMI (27/28 [96 %] vs 7/10 [70 %], p = 0.048).
CONCLUSIONS
The negative influence of not clinically suspecting AMI can be mitigated by using a tailored CT protocol.
目的
在进行 CT 检查之前，如果临床未怀疑急性肠系膜缺血（AMI），则可能漏诊。本研究旨在评估临床怀疑 AMI 对 CT 准确性的影响。
方法
这是一项回顾性单中心研究，纳入了 2014 年至 2019 年期间接受 CT 检查且临床疑似 AMI 和（或）确诊 AMI 的患者。根据每位患者的表现和未增强图像的结果，调整 CT 方案。当 CT 方案包括动脉期和门静脉期时，则认为其适用于 AMI。比较 CT 检查前有和无临床疑似 AMI 患者的 CT 方案、报告准确性和结局。
结果
在 375 个事件中，337 个（90%）为疑似 AMI，66 个（18%）为 AMI，其中 28 个（42%）为有临床疑似 AMI 的 AMI，38 个（58%）为无临床疑似 AMI 的 AMI。这两组在病史、临床表现或实验室检查方面无显著差异。在有临床疑似 AMI 的组中，更常采用适用于 AMI 的 CT 方案（26/28 [93%] vs. 28/38 [74%]，p=0.046）。有和无临床疑似 AMI 的两组之间的诊断准确性无差异（26/28 [93%] vs. 34/38 [90%]，p=1.00）。但是，在 CT 方案不适用于 AMI 的无临床疑似 AMI 组中，诊断准确性较低（27/28 [96%] vs. 7/10 [70%]，p=0.048）。
结论
通过采用量身定制的 CT 方案，可以减轻临床未怀疑 AMI 的负面影响。
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