Eur Radiol: 双能CTA灌注缺损表现是否可提示肺栓塞患者预后不良?

2021-02-25 MedSci原创 MedSci原创

双能CTA (DECTA)可以根据物质能量吸收的特征提示物质的组成,并已被用于检测PE。DECTA可以在不增加辐射剂量的情况下同时评估肺血管和实质内碘的分布。

    肺栓塞(PE)的早期诊断和治疗是提高患者预后的关键。计算机断层血管造影(CTA)是目前检测PE的参考标准,其灵敏度为83%,特异性为96%。

    双能CTA (DECTA)可以根据物质能量吸收的特征提示物质的组成,并已被用于检测PE。DECTA可以在不增加辐射剂量的情况下同时评估肺血管和实质内碘的分布。

    诊断PE时若同时患有右心室功能障碍,则其预后较右心室功能正常者要差;因此,在PE诊断时早期识别右心室功能障碍对临床治疗至关重要。CT上评估PE严重程度的两种主要方法是CTA梗阻评分(参考受累节段动脉数量及血管阻塞程度)和右室-左室比(RV/LV),后者是最重要的预后因素。


   近日,发表在European Radiology杂志的一项研究开发了一项灌注缺损评分来评估灌注缺损的严重程度,并评估灌注评分与PE严重程度的临床参数之间的关系,证实了DECTA上灌注缺损的存在和程度与PE严重程度具有相关性并且可预测PE患者的总生存率。

    我们回顾性地对2014年1月至2014年9月之间怀疑患有PE的患者所行的1136例连续DECTA诊断检查进行了研究。记录了梗阻性和非梗阻性PE的存在和位置、右室-左室比(RV/LV)和下腔静脉(IVC)回流。检查碘图以确定灌注缺损的存在,并通过基于评分的节段性灌注受损来确定其程度。随后,灌注缺陷评分与临床参数相关,包括生命体征、心电图(ECG)异常、超声心动图、肌钙蛋白和脑钠肽(bnp)水平。还记录了有关原发肿瘤诊断、肿瘤分期和死亡日期(如适用)的临床信息。

    1136例诊断性碘图中,96例患者在碘图上存在灌注缺陷。单因素和多因素分析后发现,灌注缺损与右心室/左心室比值(p = 0.05)、下腔静脉回流(p = 0.03)、肌钙蛋白升高(p = 0.03)和超声心动图显示的右心功能障碍(p = 0.05)存在显著相关。灌注缺损评分越大,下腔静脉回流(p = 0.005)和梗阻性PE (p = 0.002)发生的可能性越高。调整肿瘤分期后,具有灌注缺陷和较高灌注缺陷评分的患者有较高的死亡率(p = 0.005)。

表1 临床、CT和超声心动图表现与灌注缺陷评分的关系

表2 灌注缺陷阳性患者阻塞性PE状态与临床、超声心动图和CT表现的关系

1 对照组和研究组生存率比较的Kaplan Meier曲线。

a. stage I,b. stage II,c. stage III,d. stage IV

 

    PE患者在DECTA显示灌注缺陷与右心功能障碍有相关性。此外,灌注缺陷的存在和程度是癌症患者生存期的阴性预测因素。


原始出处:

Rocio Perez-Johnston,Andrew J Plodkowski,Darragh F Halpenny,et al. Perfusion defects on dual-energy CTA in patients with suspected pulmonary embolism correlate with right heart strain and lower survival. DOI:10.1007/s00330-020-07333-3

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    2021-02-25 12382c39m81暂无昵称

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