Johnson M S, Stine S B, Shah H, Harris V J, Ambrosius W T, Trerotola S O
Department of Radiology, Indiana University School of Medicine, Indiana University Hospital, Indianapolis 46202-5253, USA.
Radiology. 1998 Apr;207(1):131-8. doi: 10.1148/radiology.207.1.9530308.
To determine whether intraarterial digital subtraction angiography (DSA) is as accurate as cut-film (film hard-copy) angiography (CFA) in the evaluation of suspected pulmonary embolus.
Under a protocol approved by the institutional review board, CFA and DSA images were obtained in identical posteroanterior and oblique projections in one lung of each patient undergoing pulmonary angiography (n = 80). Diagnoses based on results of blinded review of each study (CFA vs DSA) by three separate reviewers (80 patients x three reviewers = 240 diagnoses for each modality) were compared with the diagnoses made by the physician who performed the procedure on the basis of CFA, DSA, and clinical data and with the consensus diagnoses obtained by means of group review of both studies together if necessary. The reviewers' confidence in their diagnoses was graded from 1 (certain) to 10 (uncertain).
Pulmonary emboli were present in 13 (16%) of 80 patients. Two hundred thirty-six (98.3%) of 240 DSA diagnoses and 231 (96.3%) of 240 CFA diagnoses were correct. The sensitivity (correct identification of emboli by all three reviewers) of DSA was 92% and of CFA was 69% (P = .083). The specificities of the modalities were not statistically significantly different. The reviewers' confidence was significantly better in their DSA diagnoses than in their CFA diagnoses (P < .004).
DSA allows more confident detection of pulmonary embolus than does CFA, with no loss in diagnostic accuracy.
确定在疑似肺栓塞评估中，动脉内数字减影血管造影（DSA）与胶片血管造影（CFA）的准确性是否相同。
在机构审查委员会批准的方案下，对接受肺血管造影的每位患者（n = 80）的一侧肺，以相同的正位和斜位投照获取CFA和DSA图像。由三位独立阅片者对每项研究（CFA与DSA）进行盲法阅片得出的诊断结果（80例患者×三位阅片者 = 每种方式240个诊断），与实施检查的医生基于CFA、DSA和临床数据做出的诊断进行比较，并在必要时与通过对两项研究进行集体阅片得出的共识诊断进行比较。阅片者对其诊断的信心从1（确定）到10（不确定）进行分级。
80例患者中有13例（16%）存在肺栓塞。240个DSA诊断中有236个（98.3%）正确，240个CFA诊断中有231个（96.3%）正确。DSA的敏感性（三位阅片者均正确识别栓塞）为92%，CFA为69%（P = 0.083）。两种方式的特异性在统计学上无显著差异。阅片者对DSA诊断的信心明显高于对CFA诊断的信心（P < 0.004）。
与CFA相比，DSA能更有信心地检测出肺栓塞，且诊断准确性无损失。
