Multidetector computed tomography for acute pulmonary embolism
Multidetector computed tomography for acute pulmonary embolism
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DOI：
10.1056/nejmoa052367
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发表时间：
2006-06-01
影响因子：
158.5
通讯作者：
Woodard, Pamela K.
中科院分区：
文献类型：
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作者：
Stein, Paul D.;Fowler, Sarah E.;Woodard, Pamela K.
背景：多层螺旋CT血管成像(CTA)诊断急性肺栓塞的准确性尚未确定。方法：肺栓塞诊断II期前瞻性研究是一项多层螺旋CT血管成像(CTA-CTV)联合多层螺旋CT血管成像(CTA-CTV)诊断急性肺栓塞的前瞻性多中心研究。结果：在824例有参考诊断和完整CT检查的患者中，有51例CTA因图像质量差而不能确定诊断。排除这些不确定的研究，CTA的敏感性为83%，特异性为96%。阳性预测值为96%，符合临床评估的高概率或低概率，92%的临床评估为中等概率，如果临床概率不一致，则不能诊断。在824例患者中，有87例CTA-CTV不确定，因为CTA或CTV的图像质量都很差。CTA-CTV诊断肺栓塞的敏感性为90%，特异性为95%。结论：在疑似肺栓塞患者中，多层螺旋CTA-CTV的诊断敏感性高于单独CTA，但特异性相近。CTA或CTA-CTV的预测价值很高，与临床评估相一致，但当临床概率与影像结果不一致时，需要进行额外的测试。
Background: The accuracy of multidetector computed tomographic angiography (CTA) for the diagnosis of acute pulmonary embolism has not been determined conclusively.Methods: The Prospective Investigation of Pulmonary Embolism Diagnosis II trial was a prospective, multicenter investigation of the accuracy of multidetector CTA alone and combined with venous-phase imaging (CTA-CTV) for the diagnosis of acute pulmonary embolism. We used a composite reference test to confirm or rule out the diagnosis of pulmonary embolism.Results: Among 824 patients with a reference diagnosis and a completed CT study, CTA was inconclusive in 51 because of poor image quality. Excluding such inconclusive studies, the sensitivity of CTA was 83 percent and the specificity was 96 percent. Positive predictive values were 96 percent with a concordantly high or low probability on clinical assessment, 92 percent with an intermediate probability on clinical assessment, and nondiagnostic if clinical probability was discordant. CTA-CTV was inconclusive in 87 of 824 patients because the image quality of either CTA or CTV was poor. The sensitivity of CTA-CTV for pulmonary embolism was 90 percent, and specificity was 95 percent. CTA-CTV was also nondiagnostic with a discordant clinical probability.Conclusions: In patients with suspected pulmonary embolism, multidetector CTA-CTV has a higher diagnostic sensitivity than does CTA alone, with similar specificity. The predictive value of either CTA or CTA-CTV is high with a concordant clinical assessment, but additional testing is necessary when the clinical probability is inconsistent with the imaging results.