数字减法血管学识别的虚假阳性创伤性脊柱动脉损伤的管理变化
Zixin Yi1, Jessica Vankawala1, Manisha Koneru2
1Cooper Medical School of Rowan University, Camden, NJ, USA.
概括
数字减去血管造影 (DSA) 可以改变最初通过CT血管造影 (CTA) 确定的疑似创伤性脊椎动脉损伤 (TVAI) 的患者的临床管理. 负的DSA结果显著影响治疗决策,包括停止抗血栓治疗.
科学领域:
- 放射学 放射学是一门学科.
- 血管成像 血管成像
- 创伤外科 手术 创伤外科
背景情况:
- 图像扫描血管造影 (CTA) 是疑似创伤性脊椎动脉损伤 (TVAI) 的初始查工具.
- 数字减去血管学 (DSA) 是确认脑血管损伤的黄金标准,因为它的高灵敏度和特异性.
研究的目的:
- 调查随访DSA的诊断信息如何影响CTA最初检测到的TVAI患者的临床管理.
- 为了比较TVAI的DSA前后的管理策略.
主要方法:
- 在一级创伤中心7年 (2016-2023) 接受CTA和DSA治疗的69名患者的回顾性评估.
- 倾向性得分匹配分析用于比较DSA前后的管理方法.
主要成果:
- 24.6%的患者在CTA上有虚假阳性TVAI发现,DSA证实为阴性.
- 在DSA阳性和DSA阴性队列之间观察到管理变化的显著差异 (p=0.02).
- DSA结果显著影响了管理变化 (p=0.03),每增加一个管理变化的患者的NNI为3.2.
结论:
- 随访DSA显著影响临床管理,即使最初的CTA建议TVAI.
- 负的DSA发现可以导致停止抗血栓剂.
- 对于具有阳性CTA发现的TVAI患者,可以考虑DSA,以完善诊断并优化结果.
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