| 梁田,刘会,谢晟,常飞燕,刘桐希,刘敏,王武.肺动脉CTA漏诊亚段肺栓塞原因分析[J].中国医学影像技术,2018,34(8):1220~1223 |
| 肺动脉CTA漏诊亚段肺栓塞原因分析 |
| Analysis of missed diagnosis of sub-segmental pulmonary embolism with pulmonary CTA |
| 投稿时间：2017-12-05 修订日期：2018-04-24 |
| DOI：10.13929/j.1003-3289.201712033 |
| 中文关键词: 体层摄影术,X线计算机 血管造影术 肺栓塞 |
| 英文关键词:Tomography, X-ray computed Angiography Pulmonary embolism |
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| 中文摘要: |
| 目的 探讨CTPA漏诊亚段肺栓塞（SSPE）的常见原因。方法 对临床确诊肺栓塞（PE）的91例患者的影像学资料进行回顾性分析，计算首诊CTPA、复诊CTPA及经查看肺通气/灌注（V/Q）显像结果后复诊CTPA对SSPE的检出率，并与V/Q显像结果进行比较。结果 91例PE患者中，3 494支亚段肺动脉显示清楚。肺V/Q显像对SSPE的检出率为19.00%（664/3 494），首诊CTPA的检出率为11.99%（419/3 494），差异有统计学意义（χ2=65.59，P<0.01）；复诊CTPA检出率为13.62%（476/3 494），低于肺V/Q显像（χ2=37.05，P<0.01）；查看肺V/Q显像结果后，复诊CTPA对SSPE的检出率为15.83%（553/3 494），与肺V/Q显像比较差异有统计学意义（χ2=12.26，P<0.01）。结论 CTPA漏诊SSPE的原因主要包括亚段肺动脉观察困难、诊断水平较低和对慢性PE诊断困难。提高阅片医师注意力和针对性，并联合肺V/Q显像，可提高CTPA对SSPE的检出率。 |
| 英文摘要: |
| Objective To explore the causes of missed diagnosis of sub-segmental pulmonary embolism (SSPE) with CT pulmonary angiography (CTPA). Methods Image data of 91 patients with clinically diagnosed pulmonary embolism (PE) were retrospectively analyzed. The detection rate of SSPE was evaluated with three methods, including first diagnosed CTPA, re-diagnosed CTPA and re-diagnosed CTPA after checking the results of pulmonary ventilation/perfusion (V/Q) imaging, and the results were compared with those of V/Q imaging. Results Among 91 patients with PE, 3 494 sub-segmental pulmonary arteries were clearly displayed with CTPA. The detection rate of pulmonary V/Q imaging for SSPE was 19.00% (664/3 494), of first diagnosed CTPA was 11.99% (419/3 494, χ2=65.59, P<0.01). The detection rate of re-diagnosed CTPA for SSPE was 13.62% (476/3 494), lower than that of pulmonary V/Q imaging (χ2=37.05, P<0.01). The detection rate of re-diagnosed CTPA for SSPE after examining the results of pulmonary V/Q imaging was 15.83% (553/3 494), statistically different with that of lung V/Q imaging (χ2=12.26, P<0.01). Conclusion The main causes of missed diagnosis of SSPE of CTPA include difficulties in observing sub-segmental pulmonary arteries, lower diagnostic level and difficulties in diagnosing chronic PE. Improving the attention and pertinence of radiographers, and combining with pulmonary V/Q imaging may improve the detection rate of SSPE. |
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