Contribution of indirect computed tomography venography to computed tomography angiography of the chest for the diagnosis of thromboembolic disease in two United States emergency departments
Contribution of indirect computed tomography venography to computed tomography angiography of the chest for the diagnosis of thromboembolic disease in two United States emergency departments
复制标题
间接计算机断层扫描静脉造影对胸部计算机断层扫描血管造影对美国两个急诊室血栓栓塞性疾病诊断的贡献
DOI：
--
复制
发表时间：
2003
影响因子：
10.4
通讯作者：
J. Kline
中科院分区：
文献类型：
--
作者：
P. Richman;J. Wood;David Kasper;J. Collins;R. Petri;Adam G. Field;D. N. Cowles;J. Kline
总结：最近的报告表明，在非卧床情况下，医生可以在胸部螺旋CT血管造影（CTA）后立即使用下肢间接CT静脉造影（CTV）来识别CTA阴性的患者，这些患者在CTV上发现了血栓栓塞性疾病。 我们试图确定急诊科（艾德）患者中CTV发现的孤立性深静脉血栓形成（DVT）的频率，这些患者主诉提示肺栓塞（PE），但CTA为阴性。本研究在郊区和城市艾德进行，其中对有疑似PE症状的患者进行了CTA和CTV初步评价。共800例患者进行了研究，其中360例来自郊区艾德和440例来自城市ED。88例（11%）患者被诊断为血栓栓塞性疾病的CTA，或CTV，或两者兼而有之。73例患者的胸部CTA为PE阳性，其中42例（5.2%）患者在CTA上有PE证据，在CTV上有DVT证据。15例患者（2%，95% CI = 1-3%）CTA阴性，随后发现CTV上有孤立性DVT，所有患者均接受抗凝治疗。 这些数据表明，在疑似PE的艾德患者中，胸部CT血管造影后立即进行间接CT静脉造影显著增加了需要抗凝治疗的血栓栓塞性疾病的诊断频率。
Summary. Recent reports suggest that physicians in non‐ambulatory settings can use indirect CT venography (CTV) of the lower extremities immediately following spiral CT angiography (CTA) of the chest to identify patients with a negative CTA who have thromboembolic disease identified on CTV. We sought to determine the frequency of isolated deep venous thrombosis (DVT) discovered on CTV in emergency department (ED) patients with complaints suggestive of pulmonary embolism (PE) yet having a negative CTA. This study was conducted in a suburban and urban ED where patients with symptoms suspicious for PE were primarily evaluated with CTA and CTV. A total of 800 patients were studied, including 360 from the suburban ED and 440 from the urban ED. 88 (11%) patients were diagnosed with thromboembolic disease by CTA, or CTV, or both. Seventy‐three patients had a CTA of the chest that was positive for PE, 42 (5.2%) of whom had evidence of both PE on CTA and DVT on CTV. Fifteen patients (2%, 95% CI = 1–3%) had a negative CTA and were subsequently found to have isolated DVT on CTV, all of whom received anticoagulation therapy. These data suggest that indirect CT venography of immediately following CT angiography of the chest significantly increased the frequency of diagnosed thromboembolic disease requiring anticoagulation in ED patients with suspected PE.