Evaluation of the lower extremity veins in patients with suspected pulmonary embolism: A retrospective comparison of helical CT venography and sonography
Evaluation of the lower extremity veins in patients with suspected pulmonary embolism: A retrospective comparison of helical CT venography and sonography
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DOI：
10.2214/ajr.175.6.1751525
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发表时间：
2000-12-01
影响因子：
5
通讯作者：
Berkmen, YM
中科院分区：
文献类型：
--
作者：
Duwe, KM;Shiau, M;Berkmen, YM
目的，在接受 CT 血管造影和 CT 静脉造影联合方案的患者中，比较螺旋 CT 静脉造影与下肢超声检查检测深静脉血栓的准确性。材料和方法。确定在 1 周内接受 CT 血管造影和 CT 静脉造影联合治疗以及下肢超声检查的患者。最终报告评估了是否存在深静脉血栓形成。计算了螺旋 CT 静脉造影识别深静脉血栓形成的统计指标。在每个真阳性病例中，对两种技术识别的血栓位置进行了比较。对所有假阳性和假阴性病例进行了审查，以确定差异的原因。 结果。七十四名患者被纳入其中。有 8 名患者 (11%) 为真阳性结果，61 名患者 (82%) 为真阴性结果，4 名患者 (5%) 为假阳性结果，1 名患者 (1%) 为假阴性结果。比较螺旋CT静脉造影与超声检查检测下肢深静脉血栓的敏感性，测量结果为89%；特异性，94%；阳性预测值，67%：阴性预测值，98%；准确率93%。在 8 例真阳性病例中，5 例的血栓部位与 CT 静脉造影和超声检查一致。在五个不一致的病例中，四个是假阳性，一个是假阴性。确定了所有差异的可能解释。结论。与超声检查相比，CT静脉造影识别深静脉血栓的准确率为93%。然而，CT静脉造影的阳性预测值仅为67%，这表明在开始抗凝治疗之前应使用超声检查来确认孤立性深静脉血栓的存在。此外，在解释 CT 静脉造影时应了解某些陷阱。
OBJECTIVE, In patients undergoing a combined CT angiographic and CT venographic protocol, the accuracy of helical CT venography for the detection of deep venous thrombosis was compared with that of lower extremity sonography.MATERIALS AND METHODS. Patients who had undergone a combined CT angiographic and CT venographic protocol and sonography of the lower extremities within 1 week were identified. The final reports were evaluated for the presence or absence of deep venous thrombosis. Statistical measures for the identification of deep venous thrombosis with helical CT venography were calculated. In each true-positive case, the location of the thrombus identified with both techniques was compared. All false-positive and false-negative cases were reviewed to identify the reasons for the discrepancies.RESULTS. Seventy-four patients were included. There were eight patients (11%) with true-positive findings, 61 patients (82%) with true-negative findings, four patients (5%) with false-positive findings, and one patient (1%) with a false-negative finding. When comparing helical CT venography with sonography for the detection of lower extremity deep venous thrombosis, the sensitivity measured 89%; specificity, 94%; positive predictive value, 67%: negative predictive value, 98%; and accuracy, 93%. Of the eight true-positive cases, five had sites of thrombus that were in agreement on both CT venography and sonography. Of the five discordant cases, four were false-positives and one was a false-negative. Possible explanations for all discrepancies were identified.CONCLUSION. Compared with sonography, CT venography had a 93% accuracy in identifying deep venous thrombosis. However, the positive predictive value of only 67% for CT venography suggests that sonography should be used to confirm the presence of isolated deep venous thrombosis before anticoagulation is initiated. In addition, interpretation of CT venography should be performed with knowledge of certain pitfalls.