Drucker E A, Rivitz S M, Shepard J A, Boiselle P M, Trotman-Dickenson B, Welch T J, Maus T P, Miller S W, Kaufman J A, Waltman A C, McLoud T C, Athanasoulis C A
Dept. of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA.
Radiology. 1998 Oct;209(1):235-41. doi: 10.1148/radiology.209.1.9769837.
To determine the sensitivity and specificity of helical computed tomography (CT) for the diagnosis of acute pulmonary embolism.
This prospective study included 47 patients who underwent pulmonary arteriography for evaluation for possible acute pulmonary embolism. Tailored helical CT and pulmonary arteriography were performed within 24 hours of each other. Each CT scan was interpreted by two chest radiologists, blinded to arteriographic results, at two institutions. CT scan interpretations were compared with findings on bilateral selective pulmonary arteriograms interpreted by two vascular radiologists at one institution.
Fifteen (32%) of 47 patients had angiographically proved pulmonary embolism. For the readers at the first institution, helical CT had 60% sensitivity, 81% specificity, 60% positive predictive value, 81% negative predictive value, and 75% overall accuracy. For the readers at the second institution, helical CT had 53% sensitivity, 97% specificity, 89% positive predictive value, 82% negative predictive value, and 83% accuracy.
Detection of pulmonary embolism with helical CT may be less accurate than previously reported. Given its high specificity but relatively low sensitivity, helical CT may not have the ideal attributes of a first-line imaging study for the diagnosis of pulmonary embolism.
确定螺旋计算机断层扫描（CT）对急性肺栓塞诊断的敏感性和特异性。
这项前瞻性研究纳入了47例因可能的急性肺栓塞而接受肺动脉造影评估的患者。定制的螺旋CT和肺动脉造影在彼此24小时内进行。每次CT扫描由两个机构的两名胸部放射科医生解读，他们对血管造影结果不知情。将CT扫描解读结果与由一个机构的两名血管放射科医生解读的双侧选择性肺动脉造影结果进行比较。
47例患者中有15例（32%）经血管造影证实有肺栓塞。对于第一个机构的读者，螺旋CT的敏感性为60%，特异性为81%，阳性预测值为60%，阴性预测值为81%，总体准确率为75%。对于第二个机构的读者，螺旋CT的敏感性为53%，特异性为97%，阳性预测值为89%，阴性预测值为82%，准确率为83%。
螺旋CT对肺栓塞的检测可能不如先前报道的准确。鉴于其高特异性但相对较低的敏感性，螺旋CT可能不具备作为肺栓塞诊断一线成像研究的理想特性。
