Guo Runcai, Deng Mei, Xi Linfeng, Zhang Shuai, Xu Wenqing, Liu Min
Department of Radiology, China-Japan Friendship Hospital, Beijing 100029, P.R. China.
Department of Radiology, China-Japan Friendship Hospital of Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100029, P.R. China.
Exp Ther Med. 2024 May 29;28(2):304. doi: 10.3892/etm.2024.12593. eCollection 2024 Aug.
The object of the study was to evaluate comprehensively the value of chest non-contrasted CT (NC-CT) in detecting acute pulmonary thromboembolism (APE). All patients were categorized into two groups: i) With APE; and ii) without APE based on clinical diagnosis. Using the clot distribution on computed tomography pulmonary angiography (CTPA), APE was divided into central and peripheral APE. Imaging features including hyperdense lumen sign and peripheral wedge-shaped opacity on chest NC-CT were evaluated. The attenuation value of peripheral wedge-shaped opacity on NC-CT was compared between patients with and without APE. Among the 273 patients, there were 110 patients with APE, 49 patients with central APE and 61 patients with peripheral APE and 163 patients without APE. The hyperdense lumen sign had a sensitivity of 30.0% and a specificity of 97.6% in detecting APE. The sensitivity and specificity of hyperdense lumen sign in detecting central APE were 57.1 and 97.6%, respectively, while the relevant percentages in detecting peripheral APE were 8.2 and 97.6%, respectively. The mean attenuation value of peripheral wedge-shaped opacity in patients with APE was significantly lower than that in patients without APE (P<0.001). Regarding the age-adjusted D-dimer, there was a decrease of eight D-dimer positive cases for patients >50 years old without APE, confirmed by CTPA. In conclusion, chest NC-CT cannot be used as an alternative modality for CTPA in diagnosing APE, however, the hyperdense lumen sign had high specificity in the diagnosis of central APE. Patients with this symptom and increased D-dimer may not require further CTPA. The lower attenuation value of peripheral wedge-shaped opacity on NC-CT suggested APE, and CTPA confirmation was required. The age-adjusted D-dimer had higher specificity in excluding APE.
本研究的目的是全面评估胸部平扫CT（NC-CT）在检测急性肺血栓栓塞症（APE）中的价值。所有患者根据临床诊断分为两组：i）患有APE；ii）未患有APE。根据计算机断层扫描肺动脉造影（CTPA）上的血栓分布，APE分为中央型和外周型APE。评估胸部NC-CT上的高密度管腔征和外周楔形实变影等影像特征。比较有和无APE患者NC-CT上外周楔形实变影的衰减值。273例患者中，有110例患有APE，其中49例为中央型APE，61例为外周型APE，163例未患有APE。高密度管腔征检测APE的灵敏度为30.0%，特异度为97.6%。高密度管腔征检测中央型APE的灵敏度和特异度分别为57.1%和97.6%，而检测外周型APE的相应百分比分别为8.2%和97.6%。APE患者外周楔形实变影的平均衰减值显著低于无APE患者（P<0.001）。关于年龄校正的D-二聚体，经CTPA证实，>50岁无APE患者的D-二聚体阳性病例减少了8例。总之，胸部NC-CT不能作为CTPA诊断APE的替代方法，然而，高密度管腔征在中央型APE诊断中具有高特异度。有此症状且D-二聚体升高的患者可能无需进一步行CTPA检查。NC-CT上外周楔形实变影衰减值较低提示APE，需CTPA确诊。年龄校正的D-二聚体在排除APE方面具有更高的特异度。
