Cauvain O, Rémy-Jardin M, Rémy J, Petyt L, Beregi J P, Steinling M, Duhamel A
Service de Radiologie, Hôpital Calmette, Lille.
Rev Mal Respir. 1996;13(2):141-53.
To evaluate the accuracy of spiral CT angiography in the diagnosis of central pulmonary embolism (PE).
A retrospective study was undertaken in a population of 90 patients who were evaluated with spiral CT angiography (acquisition: 12 to 24 s with or without strict apnea; injection of 90 cm3 of 12, 20 or 30% contrast material at a rate of 4 to 7 cm3, selective pulmonary angiography of each lung (n = 55) and/or ventilation-perfusion (VP) scanning (n = 35).
Among the 55 patients evaluated with both spiral CT and angiography, central pulmonary embolism was excluded in 19 patients (34%), assessed in 29 patients (53%) whereas CT examination was considered as inconclusive in 7 patients (13%) due to interpretive difficulties at the level of obliquely oriented arteries and/or presence of hilar lymph nodes (sensitivity: 90.5%; specificity: 82.6%). With spiral CT, the finding of 95 central emboli (3 main, 61 lobar and 31 segmental) corresponded exactly to the angiographic findings; spiral CT enabled direct visualization of intraluminal filling defects (n = 95) whereas the angiographic recognition of PE was based on direct (n = 57) and indirect (n = 38) signs. Spiral CT angiography was more sensitive and specific than VP scanning.
Spiral CT angiography appears as a sensitive and specific noninvasive method for the diagnosis of central PE.
评估螺旋CT血管造影在诊断中心型肺栓塞（PE）中的准确性。
对90例患者进行回顾性研究，这些患者接受了螺旋CT血管造影检查（采集时间：12至24秒，屏气或不屏气；以4至7立方厘米/秒的速率注射90立方厘米的12%、20%或30%造影剂），对每个肺进行选择性肺血管造影（n = 55）和/或通气灌注（VP）扫描（n = 35）。
在55例同时接受螺旋CT和血管造影检查的患者中，19例（34%）排除了中心型肺栓塞，29例（53%）评估为有肺栓塞，而7例（13%）因斜行动脉层面的解读困难和/或肺门淋巴结的存在，CT检查结果被认为不确定（敏感性：90.5%；特异性：82.6%）。螺旋CT发现的95个中心型栓子（3个主肺动脉、61个叶动脉和31个段动脉）与血管造影结果完全相符；螺旋CT能够直接显示腔内充盈缺损（n = 95），而血管造影对PE的识别基于直接（n = 57）和间接（n = 38）征象。螺旋CT血管造影比VP扫描更敏感和特异。
螺旋CT血管造影似乎是一种诊断中心型PE的敏感且特异的非侵入性方法。
