Ehsanbakhsh Alireza, Hatami Farbod, Valizadeh Niloufar, Khorashadizadeh Nasrin, Norouzirad Farshad
Department of Radiology, Birjand University of Medical Sciences, Birjand, Iran.
Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran.
J Tehran Heart Cent. 2021 Oct;16(4):156-161. doi: 10.18502/jthc.v16i4.8601.
Computed tomography pulmonary angiography (CTPA) as the gold-standard examination in the detection of pulmonary embolism (PE) is contraindicated or unavailable in certain cases. The current study aimed to assess the accuracy of unenhanced CT in the diagnosis of PE. This cohort study was conducted between October 2020 and March 2021 in Birjand, Iran, on 195 participants with clinical suspicion of PE examined with multidetector computed tomography (MDCT) scanning and CTPA. The patients were categorized into 2 groups based on the diagnosis PE in CTPA results. Imaging variables in unenhanced CT scans, including hyper/hypodense intraluminal signs, pulmonary trunk enlargements, peripheral wedge-shaped opacities, and pleural effusions, were independently reviewed by 2 radiologists and then compared between the groups. There were 82 men (42.1%) and 113 women (57.9%) at a mean age ± standard deviation of 56.00±0.24 years. Based on CTPA results, PE was diagnosed in 24.1% of the study population (47/195). However, only 20 cases (42.5%) were detected by MDCT: 17 cases (85.0%) with central PE and 3 cases (15.0%) with peripheral PE. Concerning the intraluminal clot density, 12 patients (60.0%) had hyperdense signs, 3 (15.0%) had hypodense signs, and 5 (25.0%) had mixed hyper/hypodense signs. There was a significant difference between central PE and peripheral PE detected by MDCT. Intraluminal signs had the highest specificity and sensitivity (98.6% and 42.5%, area under the curve =0.734). Unenhanced MDCT has a remarkable performance in detecting PE, specifically central clots, and can, therefore, be considered an alternative modality when CTPA is not available or indicated.
计算机断层扫描肺动脉造影（CTPA）作为检测肺栓塞（PE）的金标准检查，在某些情况下是禁忌的或无法进行的。本研究旨在评估平扫CT诊断PE的准确性。这项队列研究于2020年10月至2021年3月在伊朗比尔詹德对195名临床怀疑患有PE的参与者进行，这些参与者接受了多排螺旋计算机断层扫描（MDCT）和CTPA检查。根据CTPA结果将患者分为两组。两名放射科医生独立评估平扫CT扫描中的影像变量，包括管腔内高密度/低密度征象、肺动脉主干增粗、外周楔形致密影和胸腔积液，然后在两组之间进行比较。共有82名男性（42.1%）和113名女性（57.9%），平均年龄±标准差为56.00±0.24岁。根据CTPA结果，24.1%的研究人群（47/195）被诊断为PE。然而，MDCT仅检测到20例（42.5%）：17例（85.0%）为中央型PE，3例（15.0%）为外周型PE。关于管腔内血栓密度，12例患者（60.0%）有高密度征象，3例（15.0%）有低密度征象，5例（25.0%）有混合高密度/低密度征象。MDCT检测到的中央型PE和外周型PE之间存在显著差异。管腔内征象具有最高的特异性和敏感性（98.6%和42.5%，曲线下面积=0.734）。平扫MDCT在检测PE方面，特别是中央型血栓方面具有显著性能，因此，当无法进行或不适合CTPA时，可将其视为一种替代检查方法。
