Performance of magnetic resonance angiography in suspected acute pulmonary embolism
Performance of magnetic resonance angiography in suspected acute pulmonary embolism
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DOI：
10.1160/th04-08-0495
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发表时间：
2005-03-01
影响因子：
6.7
通讯作者：
Wahl, D
中科院分区：
文献类型：
--
作者：
Blum, A;Bellou, A;Wahl, D
肺栓塞（PE）是一种常见且可能致命的疾病。非特异性发现使 PE 的临床诊断变得困难。为了评估磁共振血管造影 (MRA) 对疑似 PE 患者队列的诊断价值和观察者间一致性，我们进行了一项前瞻性临床研究。比较了 MRA 与诊断策略的敏感性和特异性，包括临床概率、D-二聚体测试、螺旋 CT、超声腿部压迫和肺血管造影。共纳入 89 例临床疑似 PE 的患者：其中 78 例 PE 临床概率为中度或高，其余 11 例为低。所有患者均接受单排或多排螺旋 CT 和注射钆 MRA（均在进入研究后 24 小时内）。担心该策略的患者会停止抗凝治疗。所有受试者均接受 3 个月的随访。 MRA 由两个经验丰富的放射科医生团队独立阅读：一组是本地的，另一组来自另一所大学中心。 63 例确诊 PE 病例中有 62 例螺旋 CT 呈阳性。 CT 结果呈阴性的患者均未出现超声检查呈阳性的情况。只有一名 CT 阴性（超声检查阴性）的患者出现复发性血栓栓塞事件。第一个团队用MRA诊断PE 47例，敏感性为71%，特异性为92%；第二组在23例中获得诊断，敏感性为31%，特异性为85%。 MRA 读数之间的观察者间一致性较低：Kappa = 0.16（-0.01 至 0.33）； p = 0.07。总之，与基于螺旋 CT 的非侵入性策略相比，MRA 的诊断价值因观察者间一致性差而受到限制。
Pulmonary embolism (PE) is a common and potentially fatal disorder. Non-specific findings make the clinical diagnosis of PE difficult. To assess the diagnostic value and inter-observer agreement of magnetic resonance angiography (MRA) in a cohort of patients with suspected PE, we conducted a prospective clinical study. MRA was compared for sensitivity and specificity to a diagnostic strategy including clinical probability, D-dimer testing, spiral CT, ultrasound leg compression and pulmonary angiography. A total of 89 patients with clinically suspected PE were included: the clinical probability of PE was intermediate or high in 78, and low in the remaining 11. All patients underwent mono- or multi-slice spiral CT and MRA with gadolinium injection (both within 24 hours of entry to the study). Anticoagulation was withheld in patients concerned about the strategy. All subjects were followed up for 3 months. MRA was read independently by two experienced teams of radiologists: one local and one from another university centre. Spiral CT was positive in 62 of 63 cases of confirmed PE. No patient with negative CT findings was positive ultrasonographically. Only one patient with a negative CT (and negative ultrasound) had a recurrent thromboembolic event. The first team diagnosed PE with MRA in 47 cases, with a sensitivity of 71% and a specificity of 92%; the second team obtained the diagnosis in 23 cases, with a sensitivity of 31% and a specificity of 85%. Inter-observer agreement between MRA reading was low: Kappa = 0.16 (-0.01 to 0.33); p = 0.07. In conclusion, compared with a non-invasive strategy based on spiral CT the diagnostic value of MRA is limited by poor inter-observer agreement.