Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands.
Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.
Thromb Res. 2024 Sep;241:109071. doi: 10.1016/j.thromres.2024.109071. Epub 2024 Jun 26.
Pulmonary infarction is a common sequela of pulmonary embolism (PE) but lacks a diagnostic reference standard. CTPA in the setting of acute PE does not reliably differentiate infarction from other consolidations, such as reversible alveolar hemorrhage or atelectasis. We aimed to assess the diagnostic accuracy for recognizing pulmonary infarction on CT in the acute phase of PE, with follow-up CT as reference.
Initial and follow-up CT scans of 33 patients with acute PE were retrospectively assessed. Two radiologists independently evaluated the presence and size of suspected pulmonary infarction on the initial CT. Confirmation of infarction was established by detection of residual densities on follow-up CT. Sensitivity, specificity and interobserver variability were calculated.
In total, 60 presumed infarctions were found in 32 patients, of which 34 infarctions in 21 patients could be confirmed at follow-up. On patient-level, observers' sensitivity/specificity were 91 %/9 %, and 73 %/46 %, respectively, with interobserver agreement by Kappa's coefficient of 0.17. Confirmed infarctions were usually larger than false positive lesions (median approximate volume of 6.6 mL [IQR 0.84-21.3] vs. 1.3 mL [IQR 0.57-6.5], p = 0.040), but still small. An occluding thrombus in a supplying vessel was predictive for confirmed infarction (OR 11, 95%CI 2.1-55), but was not discriminative.
Pulmonary infarction is a common finding in acute PE, and generally small. Radiological identification of infarction was challenging, with considerable interobserver variability. Complete obstruction of the supplying (sub)segmental pulmonary artery was found as the strongest predictor for pulmonary infarction but was not demonstrated to be discriminative.
肺梗死是肺栓塞（PE）的常见后遗症，但缺乏诊断参考标准。在急性 PE 中，CTPA 并不能可靠地区分梗死与其他实变，如可逆性肺泡出血或肺不张。我们旨在评估在急性 PE 中 CT 识别肺梗死的诊断准确性，以随访 CT 作为参考。
回顾性评估了 33 例急性 PE 患者的初始和随访 CT 扫描。两名放射科医生独立评估了初始 CT 上可疑肺梗死的存在和大小。通过在随访 CT 上检测到残留密度来确定梗死的存在。计算了敏感性、特异性和观察者间变异性。
总共在 32 例患者中发现了 60 个疑似梗死，其中 21 例患者中的 34 个梗死可以在随访时得到证实。在患者水平上，观察者的敏感性/特异性分别为 91%/9%和 73%/46%，Kappa 系数的观察者间一致性为 0.17。证实的梗死通常比假阳性病变大（中位数近似体积为 6.6mL [IQR 0.84-21.3] vs. 1.3mL [IQR 0.57-6.5]，p=0.040），但仍然很小。供应血管中的闭塞性血栓是确认性梗死的预测因素（OR 11，95%CI 2.1-55），但没有区分能力。
肺梗死是急性 PE 的常见表现，且通常较小。梗死的影像学识别具有挑战性，观察者间差异较大。供应（亚）节段肺动脉完全阻塞是肺梗死的最强预测因素，但未表现出区分能力。
