肺动脉分叉角减小：慢性肺血栓栓塞症的一种新的影像学诊断标准。

Decreased Pulmonary Artery Bifurcation Angle: A Novel Imaging Criterion for the Diagnosis of Chronic Pulmonary Thromboembolism.

机构信息

Department of Radiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Department of Emergency Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

出版信息

Iran J Med Sci. 2022 Jul;47(4):360-366. doi: 10.30476/IJMS.2021.88058.1926.

DOI:10.30476/IJMS.2021.88058.1926

PMID:35919084

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9339105/

Abstract

BACKGROUND

Chronic pulmonary thromboembolism (CTEPH) is an unusual complication of acute pulmonary embolism (PE), which is now considered to be treatable. In modern multi-detector scanners, a detailed evaluation of pulmonary artery geometry is currently possible. This study aimed to evaluate the changes in pulmonary artery bifurcation angle (PABA) in the follow-up computed tomography angiography (CTA) of patients with acute PE.

METHODS

In this cross-sectional study, the records of two tertiary-level academic hospitals were gathered from 2012 to 2019. Pulmonary artery (PA) bifurcation angle and diameter were measured. Chi square test, independent samples test, Mann-Whitney, and Pearson's tests were employed to compare data. To evaluate the cut-off point, we utilized receiver operating characteristic (ROC) curve analysis. The accuracy, sensitivity, and specificity of pulmonary artery bifurcation angle changes were calculated. A P value <0.05 was considered to be significant.

RESULTS

Forty-six patients were included in the study. No significant differences were found between patients with and without CTEPH, and PABA in the dimeters of PA trunk, right PA, and left PA in the first CTA images (P values of 0.151, 0.142, 0.891, and 0.483, respectively), while in the secondary CTA, the mean PABA was significantly smaller in patients with CTEPH (P=0.011). In the receiver operating characteristic (ROC) analysis, delta angle revealed an area under the curve of 0.745 and an optimal cutoff of 0, leading to a sensitivity of 64%, specificity of 87%, and accuracy of 76% for diagnosing CTEPH.

CONCLUSION

We showed a significant decrease in PABA in patients developing CTEPH. This parameter can be easily measured in lung CTA.

摘要

背景

慢性血栓栓塞性肺动脉高压（CTEPH）是急性肺栓塞（PE）的一种罕见并发症，目前认为该病是可治疗的。在现代多排螺旋 CT 扫描仪中，目前可以对肺动脉几何形状进行详细评估。本研究旨在评估急性 PE 患者随访 CT 肺动脉造影（CTA）中肺动脉分叉角（PABA）的变化。

方法

在这项横断面研究中，我们收集了 2012 年至 2019 年 2 家三级学术医院的记录。测量肺动脉（PA）分叉角和直径。采用卡方检验、独立样本 t 检验、Mann-Whitney 检验和 Pearson 检验比较数据。为了评估截断点，我们利用了受试者工作特征（ROC）曲线分析。计算了肺动脉分叉角变化的准确性、敏感性和特异性。P 值<0.05 为差异有统计学意义。

结果

共纳入 46 例患者。在第一次 CTA 图像中，有 CTEPH 与无 CTEPH 的患者之间，以及 PA 主干、右肺动脉和左肺动脉的直径之间的 PABA 无显著差异（P 值分别为 0.151、0.142、0.891 和 0.483），而在二次 CTA 中，有 CTEPH 的患者的平均 PABA 显著较小（P=0.011）。在 ROC 分析中，delta angle 显示曲线下面积为 0.745，最佳截断值为 0，诊断 CTEPH 的敏感性为 64%，特异性为 87%，准确性为 76%。