在怀疑肺栓塞的患者中,计算机断层肺血管扫描与通风 perfusion 肺部扫描:一种随机对照试验
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
概括
计算机断层肺血管造影 (CTPA) 是用于诊断肺栓塞的通风 perfusion (V/Q) 肺部扫描的安全替代方案. 虽然CTPA发现了更多病例,但这两种方法的遗漏血栓率都很低,这表明CTPA发现了更多病例.
科学领域:
- 放射学 放射学是一门学科.
- 诊断成像 诊断成像 诊断成像
- 心血管医学 心血管医学
背景情况:
- 透气输液 (V/Q) 肺部扫描和计算机断层扫描肺血管造影 (CTPA) 是怀疑肺栓塞的关键成像测试.
- CTPA已在很大程度上取代了V/Q扫描,但具有有限的比较数据和对其灵敏度的担忧.
研究的目的:
- 评估CTPA是否是一种安全可靠的初始成像策略,用于排除急性症状患者的肺栓塞.
主要方法:
- 一个随机的,单盲的,非劣势性试验,涉及1417名怀疑肺栓塞的患者.
- 患者被随机分配到V/Q扫描或CTPA.
- 随访3个月,监测症状性静脉血栓栓塞的患者最初诊断没有栓塞.
主要成果:
- 在19%的患者中,CTPA诊断出肺栓塞,而V/Q扫描为14.2%.
- 随后静脉血栓栓塞的发生率在两组中都很低 (CTPA为0.4%,V/Q扫描为1.0%).
- 在V/Q扫描组中发生了一次致命的肺栓塞.
结论:
- 在排除肺栓塞方面,CTPA与V/Q扫描无差.
- CTPA导致肺栓塞的初始诊断率显著提高.
- 需要进一步的研究来指导所有CTPA检测到的血栓的管理.
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