肺栓塞の疑いのある患者の肺スキャニングと肺血管図のコンピュータトモグラフィ:ランダム化制御試験
David R Anderson1, Susan R Kahn, Marc A Rodger
1Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. david.anderson@dal.ca
JAMA
|January 1, 2008
まとめ
コンピュータートモグラフィー肺動脈造影 (CTPA) は,肺栓塞の診断のための換気-透析 (V/Q) 肺スキャンの安全な代替手段です. CTPAはより多くの症例を特定しましたが,両方の方法では小血栓の発生率が低く,CTPAは小血栓の発生率が低いことを示しています.
科学分野:
- 放射線学 放射線学
- 診断用イメージング
- 心血管医学 心血管医学
背景:
- 換気-透 (V/Q) 肺スキャニングとコンピュータトモグラフィー肺血管図 (CTPA) は,肺栓塞の疑いに対する重要な画像検査です.
- CTPAはV/Qスキャニングを大きく置き換えましたが,比較データは限られており,その感度に関する懸念があります.
研究 の 目的:
- CTPAが,急性症状のある患者の肺栓塞を排除するための安全で信頼性の高い初期イメージング戦略であるかどうかを評価する.
主な方法:
- ランダム化,単盲,非劣等性試験で,肺栓塞の疑いのある1417人の患者が参加しました.
- 患者はランダムにV/QスキャンまたはCTPAに割り当てられました.
- 症状のある静脈性血栓栓塞栓症をモニタリングするために,最初は血栓塞栓症と診断されなかった患者の3ヶ月のフォローアップ.
主要な成果:
- CTPAでは,肺栓塞は患者の19.2%で診断され,V/Qスキャンでは14.2%であった.
- 後の静脈血栓栓塞栓症の発生率は,両方のグループで低い (CTPAでは0.4%対V/Qスキャンでは1.0%).
- V/Qスキャン群で1件の致死性肺栓塞が発生しました.
結論:
- CTPAは,肺栓塞を排除するためにV/Qスキャンに劣らない.
- CTPAは,肺栓塞の初期診断率を大幅に高めました.
- CTPAで検出されたすべての血栓の管理を導くためにさらなる研究が必要である.
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