Pulmonary embolism: Prognostic CT findings
Pulmonary embolism: Prognostic CT findings
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DOI：
10.1148/radiol.2423051441
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发表时间：
2007-03-01
期刊：
影响因子：
19.7
通讯作者：
Mandrekar, Jayawant N.
中科院分区：
文献类型：
--
作者：
Araoz, Philip A.;Gotway, Michael B.;Mandrekar, Jayawant N.
目的：回顾性研究三项CT检查结果-室间隔弯曲（VSB）、右心室（RV）和左心室（LV）直径之比以及栓塞负荷-是否与急性肺栓塞（PE）导致的短期死亡（定义为院内死亡或CT检查后30天内死亡，以时间较长者为准）相关。材料与方法：获得了机构审查委员会的批准，并根据HIPAA法规审查了患者信息。1997年1月1日至2002年12月31日期间，共有1193名CT扫描呈PE阳性且已获得回顾性研究授权的患者被纳入其中。扫描由两名观察员独立审查。采用单因素分析（χ 2统计量）和多因素Logistic回归分析比较CT表现与死亡风险的关系。计算观察者间变异性（kappa统计量或组内相关系数）、CT结果预测死亡的敏感性和特异性。第三个观察员回顾了不一致的情况下posthoc.Results：54%的患者是女性和46%的男性（平均年龄，63岁+/- 16）。对于观察者1，在单变量（比值比[OR]，1.98; P = 0.04）和多变量建模（OR，1.97; P = 0.05）中，VSB与死亡相关。VSB的观察者间变异性仅为一般（kappa = 0.54），观察者2未发现与死亡相关（OR，1.52; P = 0.22）。对于两位观察者，VSB预测死亡的敏感性较低（21%和18%），特异性较高（88%和87%）。RV/LV直径比和栓塞负荷均与死亡风险增加无关。对于观察者3，VSB在单变量（OR，2.10; P = 0.05）和多变量分析（OR，2.18; P = 0.05）中与死亡相关。结论：CT描绘的VSB预测PE所致死亡，但敏感性低，观察者间变异性高。RV/LV直径比和栓塞负荷与PE导致的短期死亡无关。(c)RSNA，2007年。
Purpose: To retrospectively determine whether three computed tomographic (CT) findings-ventricular septal bowing (VSB), ratio between the diameters of right ventricle (RV) and left ventricle (LV), and embolic burden-are associated with short-term death, defined as in-hospital death or death within 30 days of CT, whichever was longer, due to acute pulmonary embolism (PE).Materials and Methods: Institutional Review Board approval was obtained, and patient information was reviewed in compliance with HIPAA regulations. A total of 1193 patients with CT scans positive for PE from January 1, 1997, to December 31, 2002, who had given authorization for retrospective research were included. Scans were independently reviewed by two observers. CT findings were compared with risk of death by using univariate analysis (chi(2) statistic) and multivariate logistic regression. Interobserver variability (kappa statistic or intraclass correlation coefficient), sensitivity, and specificity of CT findings for predicting death were calculated. A third observer reviewed discrepant cases post hoc.Results: Fifty-four percent of patients were women and 46% were men (mean age, 63 years +/- 16). For observer 1, VSB was associated with death in univariate (odds ratio [OR], 1.98; P = .04) and multivariate modeling (OR, 1.97; P = .05). Interobserver variability was only fair (kappa = 0.54) for VSB, and observer 2 found no association with death (OR, 1.52; P = .22). For both observers, VSB had low sensitivity (21% and 18%) and high specificity (88% and 87%) for predicting death. Neither RV/LV diameter ratio nor embolic burden was associated with increased risk of death. For observer 3, VSB was associated with death in univariate (OR, 2.10; P = .05) and multivariate analyses (OR, 2.18; P = .05).Conclusion: CT-depicted VSB is predictive of death due to PE, but with low sensitivity and high interobserver variability. RV/LV diameter ratio and embolic burden are not associated with short-term death due to PE. (c) RSNA, 2007.