Coche E E, Müller N L, Kim K I, Wiggs B R, Mayo J R
Department of Radiology, Vancouver Hospital and Health Sciences Centre, University of British Columbia, Canada.
Radiology. 1998 Jun;207(3):753-8. doi: 10.1148/radiology.207.3.9609900.
To determine the value of parenchymal findings at contrast material-enhanced spiral computed tomography (CT) in patients suspected to have pulmonary embolism (PE).
Eighty-eight patients suspected to have PE underwent contrast-enhanced spiral CT and ventilation-perfusion scintigraphy. Concordance between CT and scintigraphic results was used to diagnose or exclude PE. Pulmonary angiography was attempted in all patients with discordant CT and scintigraphic results or indeterminate scans. Parenchymal CT scans were assessed by two radiologists who were not aware of the diagnosis and who had access only to lung window images.
Twenty-six patients had PE; 62 did not. Wedge-shaped pleural-based consolidation was seen in 16 patients with PE (62%) and 17 patients without PE (27%) (P < .05) (sensitivity, 62%; specificity, 73%). Linear bands were seen in 12 patients with PE (46%) and 13 patients without PE (21%) (P < .05) (sensitivity, 46%; specificity, 79%). There was no statistically significant difference in the frequency of non-wedge-shaped consolidation, areas of decreased attenuation, or atelectasis. Central and lower-lobe segmental pulmonary arteries that contained emboli were enlarged (P < .05).
Parenchymal findings may suggest further investigations when results of spiral CT are inconclusive in diagnosis of PE.
确定在疑似肺栓塞（PE）患者中，对比剂增强螺旋计算机断层扫描（CT）的实质表现的价值。
88例疑似PE患者接受了对比增强螺旋CT和通气灌注闪烁扫描。CT与闪烁扫描结果的一致性用于诊断或排除PE。对所有CT和闪烁扫描结果不一致或扫描结果不确定的患者尝试进行肺血管造影。两名不知道诊断结果且仅能获取肺窗图像的放射科医生对实质CT扫描进行评估。
26例患者患有PE；62例未患。16例PE患者（62%）和17例非PE患者（27%）可见楔形胸膜下实变（P <.05）（敏感性，62%；特异性，73%）。12例PE患者（46%）和13例非PE患者（21%）可见线状影（P <.05）（敏感性，46%；特异性，79%）。非楔形实变、密度减低区或肺不张的发生率无统计学显著差异。含有栓子的中央和下叶节段性肺动脉增粗（P <.05）。
当螺旋CT结果对PE诊断不明确时，实质表现可能提示进一步检查。
