肺栓塞的诊断及介入相关治疗.ppt

Spiral or electron beam CT is more accurate than ventilation-perfusion scanning，… ACCP Consensus Committee on Pulmonary Embolism. Chest 113/2/1998 Validity of Helical or EBCT Patients with Suspected Acute PE （central PE） Sensitivity 94 % （95% CI= 86-98） Specificity 94% （95% CI= 88-98） Validity of Helical or EBCT Patients with Suspected Acute PE （all pts） Sensitivity 72 % （95% CI= 59-83） Specificity 95% （95% CI= 89-98） MR Angiography holds hope for the future and has potential advantages. But at present its disadvantages， including lack of availability and relatively insufficient spatial resolution， make it unsuitable at most institutions. AJRCCM 2003， 167; 729-734 Sensitivity of spiral computed tomography， magnetic resonance angiography， and real-time magnetic resonance angiography， for detecting pulmonary emboli Sensitivity （%） Reader CT MRA RT-MRA 1 72.1 79.1 97.7 2 69.8 81.4 97.7 Overall mean 71.0 80.3 97.7 interobs agreement 0.86 0.84 1.0 Thus， d-dimer has a role in confirming and enhancing negative preliminary impressions. A recently published study of 946 patients who had CT angiography at Mayo Clinic for suspected PE revealed a sensitivity of 0.83 and specificity of 0.39， so was not considered adequate by itself to rule-out PE. This study did not test the impact of pretest probability， however. Second generation latex agglutination assays and fully automated ELISA methods are reported to have high sensitivity and similar specificity. In addition to Venous thrombosis， other causes of elevated d-dimer include Severe Infection， Malignancy， DIC， CHF， Chronic Renal Failure， Stroke， Connective Tissue Disease， Liver Disease， Sickle Cell Crisis， Pregnancy， Postoperative State， Trauma， Recent bleeding， and Advanced Age. Thus it’s less useful for patients already in the hospital. ELISA Released by resolving fibrin clot， Excellent negative predictive value （91-98%） for VTE， Average specificity 45%， Technician dependent， Expensi