在怀疑肺栓塞的患者中,负计算断层扫描的临床有效性:系统性审查
Rene Quiroz1, Nils Kucher, Kelly H Zou
1Department of Radiology, Brigham and Women's Hospital, Boston, Mass, USA.
JAMA
|April 28, 2005
概括
计算机断层扫描 (CT) 有效排除了肺栓塞 (PE) 的可能性,负概率为0.07. 这种诊断准确度与传统的肺血管造影相提并论,确保了患者的安全.
科学领域:
- 放射学 放射学是一门学科.
- 心血管成像 - 心血管成像
- 肺部医学 肺部医学
背景情况:
- 计算机断层扫描 (CT) 用于诊断周围肺栓塞的临床有效性仍然不确定.
- 对外围肺栓塞的CT敏感度不足是主要的限制.
研究的目的:
- 系统地审查评估基于CT的方法来排除肺栓塞 (PE) 的研究.
主要方法:
- 在PubMed,MEDLINE,EMBASE,CRISP,metaRegister和Cochrane中搜索了英语语言研究 (1990-2004).
- 包括使用对比度增强胸部CT的研究,包括>30名患者和3个月的随访,以排除急性PE.
- 提取了关于人口统计,静脉血栓栓塞事件 (VTE),CT模式,假阴性和PE相关死亡率的数据.
主要成果:
- 分析了15项研究 (3500名患者).
- 阴性CT后VTE的整体负概率 (NLR) 为0.07 (95% CI,0.05-0.11);负预测值 (NPV) 为99.1% (95% CI,98.7%-99.5%).
- 总体NLR与PE相关的死亡率为0.01 (95%CI,0.01-0.02);总体NPV为99.4% (95%CI,98.7%-99.9%).
结论:
- CT扫描显示的临床有效性与传统的肺血管造影相美,用于排除肺栓塞.
- CT是排除PE的可靠工具,具有高负预测值和VTE和死亡率的低负概率比率.
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