当前位置： SCI文献检索 > EUROPEAN RADIOLOGY期刊下所有文献 > Diagnosis of pulmonary embolism with spiral CT as a second procedure following scintigraphy.

Diagnosis of pulmonary embolism with spiral CT as a second procedure following scintigraphy.

Abstract：

:Our objective was to evaluate, in a routine clinical setting, the role of spiral CT as a second procedure in patients with clinically suspected pulmonary embolism (PE) and abnormal perfusion scan. We prospectively studied the role of spiral CT in 279 patients suspected of PE. All patients started their diagnostic algorithm with chest radiographs and perfusion scintigraphy. Depending on the results of perfusion scintigraphy, patients proceeded to subsequent levels in the algorithm: stop if perfusion scintigraphy was normal; CT and pulmonary angiography if subsegmental perfusion defects were seen; ventilation scintigraphy followed by CT when segmental perfusion defects were seen; and pulmonary angiography in this last group when results of ventilation/perfusion scintigraphy and CT were incongruent. Reference diagnosis was based on normal perfusion scintigraphy, high probability perfusion/ventilation scintigraphy in combination with abnormal CT, or pulmonary angiography. If PE was present, the largest involved branch was noted on pulmonary angiography, or on spiral CT scan in case of a high-probability ventilation/perfusion scan and a positive CT scan. A distinction was made between embolism in a segmental branch or larger, or subsegmental embolism. Two hundred seventy-nine patients had abnormal scintigraphy. In 27 patients spiral CT and/or pulmonary angiography were non-diagnostic and these were excluded for image analysis. Using spiral CT we correctly identified 117 of 135 patients with PE, and 106 of 117 patients without PE. Sensitivity and specificity was therefore 87 and 91%, respectively. Prevalence of PE was 53%. Positive and negative predictive values were, respectively, 91 and 86%. In the high-probability group, sensitivity and specificity increased to 97 and 100%, respectively, with a prevalence of 90%. In the non-high probability-group sensitivity and specificity decreased to 61 and 89%, respectively, with a prevalence of 25%. In a routine clinical setting single-detector spiral CT technology has limited value as a second diagnostic test because of low added value in patients with a high-probability lung scan and low sensitivity in patients with non-high-probability lung scan result.

journal_name

Eur Radiol

journal_title

European radiology

authors

van Strijen MJ,de Monyé W,Kieft GJ,Pattynama PM,Huisman MV,Smith SJ,Bloem JL

doi

10.1007/s00330-002-1709-3

subject

Has Abstract

pub_date

2003-07-01 00:00:00

pages

1501-7

issue

eissn

0938-7994

issn

1432-1084

journal_volume

pub_type

杂志文章,多中心研究

在线工具

Diagnosis of pulmonary embolism with spiral CT as a second procedure following scintigraphy.