螺旋CT肺血管造影诊断肺栓塞的新技术研究

发布时间：2018-08-26 09:33

【摘要】：目的：评价在CT肺血管造影检查中，计算机辅助检测（CAD）技术诊断肺栓塞的价值。材料与方法：连续性收集2010年7月至2010年12月间行CTPA检查的可疑肺栓塞或下肢深静脉血栓形成患者279例。三位高年资放射科医生（分别从事胸部放射诊断工作8年、10年、15年）对所有患者进行评估，做出的一致性诊断作为参考标准。先由两位缺乏经验的低年资医生对所有患者共同进行评估，记录栓子的位置、数目，获得的数据作为低年资医生组的资料。3个月后，再由这两位低年资医生对以上患者重新进行评估，这次借助计算机辅助检测（CAD），同样记录栓子的位置、数目，获得的数据作为“低年资医生+CAD”组的资料。CAD的诊断结果由高年资医生进行记录。分别从患者数和栓子数两个方面进行比较，评价低年资医生组、“低年资医生+CAD”组和CAD组诊断肺栓塞的准确性。统计分析采用SPSS11.5统计软件包。描述性资料采用频数分析法；组间比较采用X2检验，以P＜0.05为差异有统计学意义；组间一致性比较采用Kappa检验。结果：最终有267例患者纳入研究。在267例患者中，三位高年资医生一致诊断肺栓塞81例，检出栓子555个（肺动脉主干26个，叶动脉73个，肺段动脉254个，亚段肺动脉202个）。低年资医生组检出了81例肺栓塞患者中的67例，诊断敏感性为82.7%；检出肺栓子493个,敏感性为88.8%，在肺动脉各级（肺动脉主干、叶、段、亚段）的敏感性分别为100%（26/26）、98.6%(72/73)、89.8%(228/254)、82.7%(167/202)；“低年资医生+CAD”组检出了81例患者中的75例，诊断肺栓塞的敏感性为92.6%；检出肺栓子523个，敏感性为94.2%，在肺动脉各级（肺动脉主干、叶、段、亚段）的敏感性分别为100%（26/26）、100%（73/73）、92.1%（234/254）、94.1%（190/202）；CAD正确判断了81例中的67例，诊断敏感性为82.7%，共发现栓子305个，敏感性为55.0%，在肺动脉各级（肺动脉主干、叶、段、亚段）的敏感性为11.5%（3/26）、35.6%（26/73）、53.9%（137/254）、68.8%（139/202）。其中有6例患者低年资医生最初判断为阴性，但经CAD辅助诊断后发现了栓子。结论： CAD技术可高度敏感的检测出肺血管内栓子，，低年资医生与CAD相结合后提高了低年资医生诊断肺栓塞的敏感性，尤其是在对亚段肺栓子的发现。同时CAD的诊断结果受图像质量影响较大，应对CTPA图像进行严格控制。
[Abstract]:Objective: to evaluate the diagnostic value of (CAD) in pulmonary embolism in CT pulmonary angiography. Materials and methods: from July 2010 to December 2010, 279 patients with suspected pulmonary embolism or deep venous thrombosis of lower extremity underwent CTPA examination. Three senior radiologists (8, 10, 15 years of chest radiology, respectively) evaluated all patients and made consistent diagnoses as a reference standard. All patients were assessed by two inexperienced and junior doctors, and the location, number, and data of the embolus were recorded as data for the group of junior doctors. Three months later, Then the two junior doctors re-evaluated the above patients. This time, the location and number of emboli were also recorded by (CAD),. The obtained data were recorded by the senior physician as the data of the CAD group. The accuracy of diagnosis of pulmonary embolism was evaluated by comparing the number of patients with embolus and the number of emboli in the junior doctor group, the "junior doctor CAD" group and the CAD group. SPSS11.5 software package was used for statistical analysis. The frequency analysis was used for descriptive data, the X2 test was used for the comparison between groups, the difference was P < 0. 05, and the Kappa test was used for consistency comparison among groups. Results: 267 patients were included in the study. Among the 267 patients, 81 cases were diagnosed by 3 senior doctors, and 555 emboli were detected (26 main pulmonary arteries, 73 lobar arteries, 254 segmental pulmonary arteries and 202 subsegmental pulmonary arteries). 67 out of 81 patients with pulmonary embolism were detected in the junior doctor group, the diagnostic sensitivity was 82.7%, 493 pulmonary emboli were detected and the sensitivity was 88.8. The sensitivity was 100% (26 / 26), 98.6% (72 / 73) and 82.7% (16.7 / 202) at all levels of pulmonary artery (pulmonary artery trunk, lobe, segment, subsegment), respectively. In the CAD group, 75 of the 81 patients were diagnosed with pulmonary embolism, the sensitivity of diagnosis was 92.62.The sensitivity of detecting pulmonary emboli was 94.22%, and the sensitivity of pulmonary artery was 100% (26 / 26), 100% (73 / 73) and 94.1% (234254) / 94.1% (190-202) at all levels of pulmonary artery (main pulmonary artery, lobe, segment, subsegment), respectively. CAD correctly diagnosed 67 out of 81 patients, with a diagnostic sensitivity of 82.7. 305 emboli were found and the sensitivity was 55.0. The sensitivity was 11.5% (3 / 26), 35.6% (26 / 73), 53.9% (137254) and 68.8% (139r202) at all levels of pulmonary artery (trunk, lobe, segment, subsegmentof pulmonary artery). Six of them were diagnosed as negative at first, but embolus was found by CAD assistant diagnosis. Conclusion: CAD technique can be used to detect intravascular embolism of lung, and the combination of CAD and junior doctors can improve the sensitivity of diagnosis of pulmonary embolism, especially in the detection of subsegmental pulmonary embolism. At the same time, the diagnosis result of CAD is greatly affected by the image quality, so the CTPA image should be strictly controlled.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R563.5

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