Bergin C J, Rios G, King M A, Belezzuoli E, Luna J, Auger W R
Department of Radiology, University of California, San Diego Medical Center 92103-8756, USA.
AJR Am J Roentgenol. 1996 Jun;166(6):1371-7. doi: 10.2214/ajr.166.6.8633450.
The aims of this study were to determine the reliability of the high-resolution CT (HRCT) appearance of the lung parenchyma in distinguishing patients with chronic pulmonary thromboembolism (CPTE) from those with other pulmonary diseases and to compare HRCT with radionuclide scanning.
Sixty-seven patients for whom HRCT scans were available for review were included in the study. Twenty-eight had proven pulmonary arterial hypertension (PAH), 17 cases of which were caused by CPTE, and 39 had other pulmonary abnormalities. Diagnosis based on the HRCT appearance was attempted by two radiologists, who independently evaluated pulmonary parenchyma for a mosaic pattern of variable attenuation, for a measurable disparity in the size of pulmonary vessels, and for the presence of peripheral scars. HRCT findings were compared with radionuclide scan findings and pulmonary angiography findings.
For both readers (readers 1 and 2), sensitivity (94% and 100%, respectively) and specificity (96% and 98%, respectively) were high for distinguishing patients with CPTE from patients with other pulmonary abnormalities, including those with nonthromboembolic PAH. The average ratios of segmental vessel size were 2.2 for patients with CPTE and 1.1 for those with nonthromboembolic diseases. Mosaic attenuation was identified in all patients with CPTE but was also seen in 22% (reader 1) and 14% (reader 2) of patients with no evidence of CPTE. Radionuclide scans revealed a high probability for pulmonary emboli for all but one patient with CPTE but also revealed a high probability for three patients who had no emboli.
HRCT findings of disparity in the size of segmental vessels and a mosaic pattern of variable attenuation reliably distinguished patients with CPTE from those with nonthromboembolic PAH and from those with other pulmonary abnormalities. In addition, HRCT was more specific than radionuclide scanning in identifying patients with CPTE.
本研究旨在确定肺实质的高分辨率CT（HRCT）表现用于区分慢性肺血栓栓塞症（CPTE）患者与其他肺部疾病患者的可靠性，并将HRCT与放射性核素扫描进行比较。
本研究纳入了67例有HRCT扫描可供回顾的患者。28例确诊为肺动脉高压（PAH），其中17例由CPTE引起，39例有其他肺部异常。两名放射科医生试图根据HRCT表现进行诊断，他们独立评估肺实质，以观察有无不同程度的马赛克样衰减、肺血管大小是否存在可测量的差异以及有无周边瘢痕。将HRCT结果与放射性核素扫描结果及肺血管造影结果进行比较。
对于两位阅片者（阅片者1和阅片者2），区分CPTE患者与其他肺部异常患者（包括非血栓栓塞性PAH患者）时，敏感性（分别为94%和100%）和特异性（分别为96%和98%）均较高。CPTE患者节段性血管大小的平均比值为2.2，非血栓栓塞性疾病患者为1.1。所有CPTE患者均发现有马赛克样衰减，但在无CPTE证据的患者中，阅片者1发现22%有此表现，阅片者2发现14%有此表现。放射性核素扫描显示，除1例CPTE患者外，所有CPTE患者肺栓塞可能性高，但也显示3例无栓塞患者肺栓塞可能性高。
HRCT显示的节段性血管大小差异及不同程度的马赛克样衰减表现能可靠地区分CPTE患者与非血栓栓塞性PAH患者以及其他肺部异常患者。此外，在识别CPTE患者方面，HRCT比放射性核素扫描更具特异性。
