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Abstract：
Objective In this study, we compare the diagnostic accuracy of dual-energy (DE) computed tomography pulmonary angiography (CTPA) derived contrast enhancement (DECTPA, CTPA images with iodine maps) with standard dual-energy pulmonary angiography (SCTPA) for diagnosis of subsegmental pulmonary embolism in the cases with clinical suspicion of acute pulmonary embolism (APE). Materials and Methods We included 50 cases with clinical suspicion of APE that were referred for CTPA. All the patients underwent CTPA in the dual-energy protocol. Two radiologists evaluated the images. The first radiologist interpreted the SCTPA images (vascular images) and the second radiologist interpreted the DECTPA (CTPA images with iodine maps) for findings of APE. We calculated the sensitivity, specificity, and negative predictive value of DECTPA vis-à-vis SCTPA images. Results The DECTPA with the advantage of iodine map utilization yielded higher detection of thrombi in peripheral subsegmental arteries (72 vs. 99; p = - 0.001) as compared to the SCTPA images by identification of 18 new perfusion defects (interquartile range [IQR]: 0-1) that were consistent with APE. Filling defects were identified in 27 (IQR: 0-4) more subsegmental arteries supplying these 18 areas, which were not detected on SCTPA alone. These 18 perfusion defects were identified in 13 cases. In these 13 cases, 4 new cases were diagnosed that were negative on CTPA ( p = -0.125). In the evaluation of the APE, sensitivity and specificity were calculated and it was found that DECTPA showed 100% sensitivity and 86% specificity with 100% negative predictive value in the detection of thrombi as compared to the routine CTPA. Conclusion DECTPA has higher sensitivity and negative predictive value in the detection of the subsegmental perfusion defect identification as compared to SCTPA.
摘要：
目的在本研究中,我们比较双能（DE）计算机断层扫描肺动脉造影（CTPA）衍生的对比增强（DECTPA，带有碘图的CTPA图像）带有标准的双能量肺动脉造影（SCTPA），用于在临床怀疑急性肺栓塞（APE）的情况下诊断亚段肺栓塞。材料与方法我们纳入了50例临床怀疑为APE的患者，这些患者因CTPA转诊。所有患者均采用双能量方案进行CTPA。两名放射科医生评估了这些图像。第一放射科医师解释SCTPA图像(血管图像)并且第二放射科医师解释DECTPA(具有碘图的CTPA图像)以发现APE。我们计算了灵敏度，特异性，DECTPA对SCTPA图像的负预测值。结果具有碘图利用优势的DECTPA在外周亚段动脉中产生了更高的血栓检出率（72vs.99;p=-0.001），与SCTPA图像相比，通过鉴定18个新的灌注缺陷（四分位距[IQR]：0-1）与APE一致。在供应这18个区域的27个（IQR：0-4）更多的亚段动脉中发现了填充缺陷，在单独的SCTPA上未检测到。在13例中发现了18个灌注缺陷。在这13个案例中，诊断出4例新病例，CTPA阴性（p=-0.125）。在对APE的评估中，计算了敏感性和特异性,发现与常规CTPA相比,DECTPA在检测血栓方面表现出100%的敏感性和86%的特异性以及100%的阴性预测值.结论与SCTPA相比,DECTPA检测亚段灌注缺损具有更高的灵敏度和阴性预测值。
