改良式CT血管成像检测支气管动脉-肺动脉瘘价值分析

A clinical performance study of modified CT angiography in detecting bronchial artery-pulmonary artery fistula

目的探讨改良式CT血管成像(CTA)在检测支气管动脉-肺动脉瘘(BPF)中的临床应用价值。方法回顾性分析2017年7月至2018年12月就诊于温州医科大学附属第一医院同期行改良式CTA和DSA检查的246例咯血患者,CT采用Toshiba Aquilion one 320排640层螺旋CT机,所有改良式CTA图像由两名放射科主治以上医师盲式阅读。以DSA结果为金标准,计算改良式CTA诊断BPF的灵敏度、特异度、准确度及两者检查一致性。结果DSA检出186例阳性,60阴性;改良式CTA检出160例阳性,86例阴性。改良式CTA诊断BPF的灵敏度为85.5%(159/186),特异度为98.3%(59/60),准确度为88.6%(218/246),与DSA检查结果一致性高(kappa=0.73,P<0.01)。结论改良式CTA诊断BPF具有高特异性,可作为疑似BPF患者无创性筛查的首选方法。

Objective To evaluate the clinical value of modified computed tomography angiography(CTA)in detecting bronchial artery-pulmonary artery fistula(BPF).Methods Retrospective analysis was performed on 246 patients with hemoptysis admitted to the First Affiliated Hospital of Wenzhou Medical University from July 2017 to December 2018,who underwent modified CTA and DSA examination at the same time.CT was performed with Toshiba Aquilion one 320 row 640-slice spiral CT scanner.All modified CTA images were read blindly by two radiologists above the attending doctors.The sensitivity,specificity and accuracy of the modified CTA in diagnosing BPF were calculated with the DSA results as the reference,and the consistency of the two tests was analyzed.Results DSA detected 186 cases of positive and 60 cases of negative,modified CTA detected 160 cases of positive and 86 cases of negative.The sensitivity,specificity and accuracy of modified CTA for BPF diagnosis was 85.5%(159/186),98.3%(59/60),88.6%(218/246)respectively,and they were with high consistency with DSA examination results(kappa=0.73,P<0.01).Conclusion Modified CTA has high diagnostic specificity for BPF,which can be used as the preferred method for non-invasive screening of suspected BPF patients.