Mohamed Hala A, Farouk Nadia, Elnaeem Emad Allam Abd, Abdelfattah Mohamed T, Ali Yosra M, Abdelaziz Ali O
Chest Department, Faculty of Medicine, Minia University, Minia, Egypt.
Radiology Department, Faculty of Medicine, Minia University, Minia, Egypt.
Can J Respir Ther. 2023 Jun 6;59:123-129. doi: 10.29390/cjrt-2022-065. eCollection 2023.
The present study was designed to evaluate the role of chest ultrasound in the diagnosis of acute pulmonary embolism (PE) and determine its accuracy using multi-detector CT-pulmonary angiography (MD-CTPA) as a gold standard technique for PE diagnosis.
A prospective case-control study was performed with 75 patients who presented to the emergency department of Minia Cardiothoracic University Hospital with clinical suspicion of PE. All patients were evaluated clinically and by laboratory tests to assess the risk of PE. Thoracic ultrasound (TUS) was then performed for all patients for signs suggestive of PE. Finally, MD-CTPA was performed to confirm or exclude the presence of PE.
Patients were subdivided into two groups according to the result of MD-CTPA; group I (patients with PE) and group II (control group without PE). In our study, PE was present in the lower lobe in 75% of cases, then in the middle in 13% and in the upper lobe in 3.8% of cases. The majority of lesions in TUS were wedge-shaped lesions. No vascular flow was detected in 83% of PE-confirmed patients. The current study revealed that TUS has 81.25% sensitivity, 95% specificity, 98.3% positive predictive value, 77.2% negative predictive value and 87% accuracy in the diagnosis of PE. Univariate regression analysis revealed that the presence of wedge-shaped pleural-based lesions in grayscale US and the absence of flow signals by colour Doppler sonography (CDS) increase the possibility of PE. Wedge-shaped pleural-based lesions increase the possibility of PE by 1.48 times (P=0.0001), and the absence of flow signals by CDS increases the possibility of PE by 92.89 times (P=0.00001). Multivariate regression analysis revealed that adding absent flow signals by CDS to wedge-shaped pleural-based lesions by grayscale US increases the possibility of a PE diagnosis by 50.28 times (P=0.001).
Chest ultrasound is a simple, safe, noninvasive, inexpensive, bedside diagnostic radiological technique that can be used in the emergency department for suspected PE or as an alternative to MD-CTPA when CTPA is contraindicated. Wedge-shaped lesions and the absence of flow signals by CDS increase the diagnostic value of ultrasound for PE.
本研究旨在评估胸部超声在急性肺栓塞（PE）诊断中的作用，并以多排螺旋CT肺血管造影（MD-CTPA）作为PE诊断的金标准技术来确定其准确性。
对75例因临床怀疑PE而就诊于米尼亚心胸大学医院急诊科的患者进行了一项前瞻性病例对照研究。所有患者均进行了临床评估和实验室检查以评估PE风险。然后对所有患者进行胸部超声（TUS）检查以寻找提示PE的征象。最后进行MD-CTPA以确认或排除PE的存在。
根据MD-CTPA结果将患者分为两组；第一组（有PE的患者）和第二组（无PE的对照组）。在我们的研究中，75%的病例PE位于下叶，13%位于中叶，3.8%位于上叶。TUS中大多数病变为楔形病变。在83%确诊为PE的患者中未检测到血管血流。本研究显示TUS在PE诊断中的敏感性为81.25%，特异性为95%，阳性预测值为98.3%，阴性预测值为77.2%，准确性为87%。单因素回归分析显示，灰阶超声中基于胸膜的楔形病变的存在以及彩色多普勒超声（CDS）无血流信号增加了PE的可能性。基于胸膜的楔形病变使PE的可能性增加1.48倍（P = 0.0001），CDS无血流信号使PE的可能性增加92.89倍（P = 0.00001）。多因素回归分析显示，将CDS无血流信号添加到灰阶超声基于胸膜的楔形病变中使PE诊断的可能性增加50.28倍（P = 0.001）。
胸部超声是一种简单、安全、无创、廉价的床边诊断放射技术，可在急诊科用于疑似PE的诊断，或在CTPA禁忌时作为MD-CTPA的替代方法。楔形病变和CDS无血流信号增加了超声对PE的诊断价值。
