双源CT对急性大面积肺栓塞患者右心室功能不全的诊断价值

Diagnostic value of DSCT in detecting right ventricular dysfunction in patients with acute massive pulmonary embolism

目的探讨双源CT（DSCT）对急性大面积肺栓塞患者右心室功能不全（RVD）的诊断价值。方法回顾性分析40例经DSCT检查证实为急性大面积肺栓塞患者的临床资料。DSCT定性诊断RVD的指标有：心脏横轴观显示右心室扩大、室间隔变直或向左室内凸出，患者均在行DSCT检查前或检查后48h内行心脏超声心动图检查。以超声心动图结果为参照标准，比较分析DSCT定性方法诊断肺栓塞患者RVD的敏感性、特异性、阳性预测值、阴性预测值及两种检查方法结果的一致性。结果40例急性大面积肺栓塞患者中，DSCT定性诊断RVD30例，超声心动图诊断右心功能不全34例，DSCT定性诊断急性大面积肺栓塞患者RVD的敏感性为88．2％，特异性为100％，阳性预测值为100％，阴性预测值60％，Kappa值为0．692，P〉0．05，故两种检查方法对急性大面积肺栓塞患者右心室功能不全的诊断差异无统计学意义，具有较好的一致性。结论采用DSCT定性方法能迅速、准确地评估急性肺栓塞患者的右心室功能，是一种既简单又实用的方法，有利于指导临床治疗和预测患者预后。

Objective To investigate the diagnostic value of Dual-source CT（DSCT） with quali- tative method in detecting right ventricular dysfunction in patients with acute massive pulmonary embol- ism. Methods The clinical data of 40 patients with acute massive pulmonary embolism confirmed by DSCT were retrospectively analyzed. The DSCT diagnosis standards of right ventricular dysfunction were following： the fight ventricle was dilated or there was leftward shift of the interventricular septum or ven- tricular septal straighted. Echocardiography were performed in all patients in 48 hours before or after DSCT inspection. Echocardiographic reports serving as the reference standard. Comparative analysis the sensitivity, specificity, positive predictive value, negative predictive value and the consistency of results of the two methods with DSCT qualitative in detecting fight ventricular dysfunction in patients with acute massive pulmonary embolism. Results Among the 40 patients with acute massive pulmonary embolism, 30 patients with right ventficular dysfunction in the DSCT image, 34 patients with right ventricular dys- function in echocardiography. The results of the sensitivity, specificity, positive predictive value and neg- ative predictive value with DSCT qualitative methods in detecting right ventricular dysfunction in patients with. acute massive pulmonary were 88.2% , 100% , 100% , 60% , respectively, K = 0. 692. P 〉 0. 05 ）. Therefore, there was no significant difference between the two diagnosis methods of acute massive pulmonary embolism in patients with right ventricular dysfunction. Moreover, the diagnosis of the two methods has a good consistency in detecting fight ventricular dysfunction in patients with acute massive pulmonary. Conclusions Using DSCT qualitative method can assess right ventricular dysfunction in pa- tients with acute massive pulmonary embolism quickly and accurately, and which is a simple and practi- cal method, and is useful to guide clinical treatment and to predict the prognosis.