计算机断层扫描诊断肺梗塞在急性肺栓塞的肺梗塞
Fleur H J Kaptein1, J Lauran Stöger2, Lisette F van Dam3
1Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands.
肺梗塞在肺栓塞 (PE) 中很常见,但在初始CT扫描上难以诊断. 随访CT对于确认小心脏病发作至关重要,在诊断中显示出显著的观察者间变异性.
科学领域:
- 放射学 放射学是一门学科.
- 肺部医学 肺部医学
- 诊断成像 诊断成像 诊断成像
背景情况:
- 肺梗塞是肺栓塞 (PE) 的常见并发症.
- 目前的CTPA成像在急性PE斗争可靠地区分心脏病发作和其他肺结合.
- 没有用于肺梗塞的诊断参考标准.
研究的目的:
- 评估CT扫描的诊断准确性,以识别PE急性阶段的肺梗塞.
- 使用随访CT扫描作为确认肺梗塞的参考标准.
主要方法:
- 对33名急性PE患者的初始和后续CT扫描进行了回顾性分析.
- 两个放射科医生在最初的CT上对怀疑肺梗塞的独立评估.
- 根据在后续CT扫描中观察到的残留密度来确认心脏病发作.
主要成果:
- 在21名患者的随访中,确定了60例疑似心脏病发作,34例在随访中得到证实.
- 观察者敏感度/特异性各不相同 (91%/9%和73%/46%),表明观察者之间的一致性很低 (卡帕=0.17).
- 确定的心脏病发作通常小 (中位数为6.6毫升) 和大于假阳性;封闭性血栓预测了心脏病发作,但缺乏辨别能力.
结论:
- 肺梗塞在急性PE中很常见,通常小.
- 在初始CT上进行肺梗塞的放射性鉴定是具有挑战性的,因为观察者之间的显著变异性.
- 完整的动脉阻塞是最强的预测因素,但对确诊的心脏病发作没有歧视性.
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