动态胸部 X 线摄影对慢性血栓栓塞性肺动脉高压的疗效。
Efficacy of Dynamic Chest Radiography for Chronic Thromboembolic Pulmonary Hypertension.
机构信息
From the Departments of Clinical Radiology (Y.Y., T.K., T.H., K.S., Y. Matsuura, S.B., T.I., Y. Maruoka, Y.K., K.I.), Cardiovascular Medicine (K.A., K.H.), Hematology, Oncology & Cardiovascular Medicine (S.M.), and Health Sciences (H. Yabuuchi), Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; Division of Radiology, Department of Medical Technology, Kyushu University Hospital, Fukuoka, Japan (H. Yoshikawa); and Healthcare Business Headquarters, Konica Minolta, Inc, Hachioji, Tokyo, Japan (T.F.).
出版信息
Radiology. 2023 Mar;306(3):e220908. doi: 10.1148/radiol.220908. Epub 2022 Nov 8.
Background While current guidelines require lung ventilation-perfusion (V/Q) scanning as the first step to diagnose chronic pulmonary embolism in pulmonary hypertension (PH), its use may be limited by low availability and/or exposure to ionizing radiation. Purpose To compare the performance of dynamic chest radiography (DCR) and lung V/Q scanning for detection of chronic thromboembolic PH (CTEPH). Materials and Methods Patients with PH who underwent DCR and V/Q scanning in the supine position from December 2019 to July 2021 were retrospectively screened. The diagnosis of CTEPH was confirmed with right heart catheterization and invasive pulmonary angiography. Observer tests were conducted to evaluate the diagnostic accuracy of DCR and V/Q scanning. The lungs were divided into six areas (upper, middle, and lower for both) in the anteroposterior image, and the number of lung areas with thromboembolic perfusion defects was scored. Diagnostic performance was compared between DCR and V/Q scanning using the area under the receiver operating characteristic curve. Agreement between the interpretation of DCR and that of V/Q scanning was assessed using the Cohen kappa coefficient and percent agreement. Results A total of 50 patients with PH were analyzed: 29 with CTEPH (mean age, 64 years ± 15 [SD]; 19 women) and 21 without CTEPH (mean age, 61 years ± 22; 14 women). The sensitivity, specificity, and accuracy of DCR were 97%, 86%, and 92%, respectively, and those of V/Q scanning were 100%, 86%, and 94%, respectively. Areas under the receiver operating characteristic curve for DCR and V/Q scanning were 0.92 (95% CI: 0.79, 0.97) and 0.93 (95% CI: 0.78, 0.98). Agreement between the consensus interpretation of DCR and that of V/Q scanning was substantial (κ = 0.79 [95% CI: 0.61, 0.96], percent agreement = 0.9 [95% CI: 0.79, 0.95]). Conclusion Dynamic chest radiography had similar efficacy to ventilation-perfusion scanning in the detection of chronic thromboembolic pulmonary hypertension. © RSNA, 2022 See also the editorial by Wandtke and Koproth-Joslin in this issue.
背景 当前的指南要求在肺动脉高压（PH）中诊断慢性肺栓塞时首先进行肺通气-灌注（V/Q）扫描，但由于可用性和/或放射性暴露有限，其应用可能受到限制。目的 比较动态胸部 X 线摄影（DCR）和肺 V/Q 扫描在检测慢性血栓栓塞性肺动脉高压（CTEPH）中的性能。材料与方法 回顾性筛选了 2019 年 12 月至 2021 年 7 月间接受 DCR 和仰卧位 V/Q 扫描的 PH 患者。通过右心导管检查和有创性肺动脉造影确诊 CTEPH。进行观察者试验以评估 DCR 和 V/Q 扫描的诊断准确性。在前后位图像中将肺分为 6 个区域（上下各 3 个区域），并对存在血栓栓塞性灌注缺陷的肺区域数量进行评分。使用受试者工作特征曲线下面积比较 DCR 和 V/Q 扫描的诊断性能。使用 Cohen kappa 系数和百分比一致性评估 DCR 解读与 V/Q 扫描解读之间的一致性。结果 共分析了 50 例 PH 患者：29 例为 CTEPH（平均年龄，64 岁±15[标准差]；19 例女性）和 21 例非 CTEPH（平均年龄，61 岁±22；14 例女性）。DCR 的敏感性、特异性和准确性分别为 97%、86%和 92%，V/Q 扫描分别为 100%、86%和 94%。DCR 和 V/Q 扫描的受试者工作特征曲线下面积分别为 0.92（95%CI：0.79，0.97）和 0.93（95%CI：0.78，0.98）。DCR 和 V/Q 扫描共识解读之间的一致性较高（κ=0.79[95%CI：0.61，0.96]，百分比一致性=0.9[95%CI：0.79，0.95]）。结论 DCR 在检测慢性血栓栓塞性肺动脉高压方面与 V/Q 扫描具有相似的效果。
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