CT venography and compression sonography are diagnostically equivalent: Data from PIOPED II
CT venography and compression sonography are diagnostically equivalent: Data from PIOPED II
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DOI：
10.2214/ajr.07.2388
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发表时间：
2007-11-01
影响因子：
5
通讯作者：
Beemath, Afzal
中科院分区：
文献类型：
--
作者：
Goodman, Lawrence R.;Stein, Paul D.;Beemath, Afzal
客观的。本研究的目的是比较 MDCT 血管造影 (CTA) 后 CT 静脉造影 (CTV) 与静脉压缩超声检查诊断静脉血栓栓塞 (VTE) 的临床价值。肺栓塞诊断 II (PIOPED II) 前瞻性调查显示，下肢影像学检测出的需要抗凝治疗的患者比单独 CTA 多出约 7%。 对象和方法。 PIOPED II 是一项前瞻性多中心研究，调查单独使用 CTA 以及结合使用 CTA 和 CTV 的准确性。使用复合参考标准来确认或排除肺栓塞。 711 名患者获得了足够质量的 CTV 和超声图像。 结果。 CTV 和超声检查在诊断或排除深静脉血栓 (DVT) 方面的一致性为 95.5%； kappa 统计值为 0.809。联合CTA和CTV的敏感性和特异性与联合CTA和超声检查的敏感性和特异性相当。无论使用 CTV 还是超声检查，亚组（包括有 DVT 体征或症状的患者、无症状患者和有 DVT 病史的患者）的诊断结果相似。有 DVT 体征或症状的患者发生 DVT 的可能性是普通患者的 8 倍，有 DVT 病史的患者出现阳性结果的可能性是普通患者的两倍。结论。 CTV 和超声检查在诊断或排除 DVT 方面显示出相似的结果。在没有 DVT 体征、症状或病史的患者中，阳性研究的发生率较低。从临床意义来看，CT静脉造影和下肢超声检查的诊断结果相当；在没有 DVT 体征、症状或病史的患者中，阳性研究的发生率较低；因此，可以根据安全性、费用和时间限制来选择成像技术。
OBJECTIVE. The purpose of this study was to compare the clinical value of CT venography (CTV) after MDCT angiography (CTA) with venous compression sonography for the diagnosis of venous thromboembolism (VTE). The Prospective Investigation of Pulmonary Embolism Diagnosis II (PIOPED II) showed that lower extremity imaging detects about 7% more patients requiring anticoagulation than CTA alone.SUBJECTS AND METHODS. PIOPED II was a prospective multicenter study investigating the accuracy of CTA alone and CTA and CTV together. A composite reference standard was used to confirm, or rule out, pulmonary embolus. Adequate quality CTV and sonographic images were obtained in 711 patients.RESULTS. There was 95.5% concordance between CTV and sonography for the diagnosis or exclusion of deep venous thrombosis (DVT); the kappa statistic was 0.809. The sensitivity and specificity of combined CTA and CTV were equivalent to those of combined CTA and sonography. Diagnostic results in subgroups, including patients with signs or symptoms of DVT, asymptomatic patients, and patients with a history of DVT, were similar whether CTV or sonography was used. Patients with signs or symptoms of DVT were eight times more likely to have DVT, and patients with a history of DVT were twice as likely to have positive findings.CONCLUSION. CTV and sonography showed similar results in diagnosing or excluding DVT. The incidence of positive studies in patients without signs, symptoms, or history of DVT is low. In terms of clinical significance, CT venography and lower extremity sonography yield equivalent diagnostic results; the incidence of positive studies in patients without signs, symptoms, or history of DVT is low; thus the choice of imaging technique can be made on the basis of safety, expense, and time constraints.