急性肺栓塞所致右心功能不全的CTPA诊断价值  

Diagnostic Value of CT Pulmonary Angiography for Right Ventricular Dysfunction Secondary to Acute Pulmonary Embolism

作　　者：王建国[1] 朱力[2] 刘敏[3] 郭晓娟[3] 王辰[3] 杨媛华[3] 翟振国[3] 郭佑民[1] 马红霞[2] 郭玉林[2] 

机构地区：[1]西安交通大学医学院第二医院影像中心,陕西西安710004 [2]宁夏医学院附属医院影像中心 [3]首都医科大学附属北京朝阳医院放射科

出　　处：《实用放射学杂志》2008年第9期1205-1209,共5页Journal of Practical Radiology

基　　金：国家"十一五"科技攻关项目(2006BAI01A06);深圳市罗湖区科技计划项目(2007029)

摘　　要：目的探讨CT肺血管造影(CTPA)对急性肺栓塞(PE)所引起的右心功能不全(RVD)的诊断价值。方法回顾性分析经CTPA确诊的、并于24h内行超声心动图(UCG)检查的急性肺栓塞患者36例,并按病情严重性分为大面积肺栓塞组(24例)和非大面积肺栓塞组(12例)。本研究以UCG的结果作为RVD的诊断标准,将CTPA的结果与UCG的结果相对照。CTPA诊断RVD的标准为在横切位CT图像上显示右心室增大(RVd/LVd>1)或室间隔异常移位。结果36例肺栓塞患者中,UCG共诊断RVD阳性13例,阴性23例。CTPA诊断RVD阳性16例,阴性20例。以UCG为标准,CTPA的诊断敏感性为84.61%、特异性为78.26%、阳性似然比为3.892、阴性似然比为0.197、阳性预测值为68.75%、阴性预测值为90%,Kappa值为0.60,诊断具有中等一致性。24例大面积肺栓塞患者中,UCG诊断RVD阳性13例,阴性11例。CTPA诊断RVD阳性14例,阴性10例。以UCG为标准,CTPA的诊断敏感性为84.61%、特异性为72.73%、阳性似然比为3.103、阴性似然比为0.212、阳性预测值为78.57%、阴性预测值为80%,Kappa值为0.58,诊断具有中等一致性。12例非大面积肺栓塞患者中,UCG诊断均为RVD阴性。CTPA诊断RVD阳性2例,阴性10例,诊断特异性为83.33%。统计学分析发现,2组之间的RVd/LVd值有显著性差异,CTPA与UCG结果在大面积肺栓塞组有较好的相关性,而在非大面积肺栓塞组无明显相关性。结论CTPA不仅可以对肺栓塞做出直接诊断,而且通过分析心脏的形态学改变,可以较为准确地判定肺栓塞患者是否伴发右心功能不全。Objective To evaluate the role of CT pulmonary angiography（ CTPA ） in detecting right ventricular dysfunction （ RVD ） secondary to acute pulmonary embolism （ PE ）. Methods Thirty - six patients with CTPA - confirmed PE and underwent ultrasonic eeboeardiography （UCG） within the ensuing 24 hours were retrospectively reviewed. According to the severity of the disease, the patients were divided into the massive PE group（ 24 cases） and non -massive PE group（ 12 cases） respectively. CT scans were analyzed for findings suggestive of RVD. Scans were considered positive for RVD if the right ventricle was dilated（ RVd/LVd 〉 1 ） or if the interventricular septum was straightened or deviated towards the left ventricle. The results were then compared with that of UCG to estimate the value of CTPA in detecting RVD associated with PE. Results Of 36 patients with acute PE, UCG identified that 13 patients were positive for RVD and 23 patients were negative for RVD. Meanwhile, 16 cases were diagnosed as positive and 20 patients as negative for RVD by CTPA. In comparison with UCG, the diagnostic sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positi.ve predictive value and negative predictive value of CTPA were 84.61% , 78.26% , 3. 892, 0. 197, 68.75% and 90% ,respectively. Kappa value was 0.60, which suggested moderate agreement between CTPA and UCG in the whole level. In the massive PE group, the diagnostic sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positive predictive value and negative predictive value of CTPA were 84.61% , 72.73% , 3. 103, 0. 212, 78.57% and 80% , respectively . Kappa value was 0.58 , which suggested moderate agreement between CTPA and UCG in the massive PE group. In the non - massive PE group, the diagnostic specificity was 83.33%. By statistics, the value of RVd/LVd had apparent difference between the two groups, and the results of CTPA and UCG had good correlation in the massive PE group but no apparent correl

关 键 词：肺 肺栓塞 体层摄影术 X线计算机 右心功能不全 

分 类 号：R563.5[医药卫生—呼吸系统] R814.42[医药卫生—内科学]