【摘要】：目的：評(píng)價(jià)在CT肺血管造影檢查中，計(jì)算機(jī)輔助檢測(cè)（CAD）技術(shù)診斷肺栓塞的價(jià)值。材料與方法：連續(xù)性收集2010年7月至2010年12月間行CTPA檢查的可疑肺栓塞或下肢深靜脈血栓形成患者279例。三位高年資放射科醫(yī)生（分別從事胸部放射診斷工作8年、10年、15年）對(duì)所有患者進(jìn)行評(píng)估，做出的一致性診斷作為參考標(biāo)準(zhǔn)。先由兩位缺乏經(jīng)驗(yàn)的低年資醫(yī)生對(duì)所有患者共同進(jìn)行評(píng)估，記錄栓子的位置、數(shù)目，獲得的數(shù)據(jù)作為低年資醫(yī)生組的資料。3個(gè)月后，再由這兩位低年資醫(yī)生對(duì)以上患者重新進(jìn)行評(píng)估，這次借助計(jì)算機(jī)輔助檢測(cè)（CAD），同樣記錄栓子的位置、數(shù)目，獲得的數(shù)據(jù)作為“低年資醫(yī)生+CAD”組的資料。CAD的診斷結(jié)果由高年資醫(yī)生進(jìn)行記錄。分別從患者數(shù)和栓子數(shù)兩個(gè)方面進(jìn)行比較，評(píng)價(jià)低年資醫(yī)生組、“低年資醫(yī)生+CAD”組和CAD組診斷肺栓塞的準(zhǔn)確性。統(tǒng)計(jì)分析采用SPSS11.5統(tǒng)計(jì)軟件包。描述性資料采用頻數(shù)分析法；組間比較采用X2檢驗(yàn)，以P＜0.05為差異有統(tǒng)計(jì)學(xué)意義；組間一致性比較采用Kappa檢驗(yàn)。結(jié)果：最終有267例患者納入研究。在267例患者中，三位高年資醫(yī)生一致診斷肺栓塞81例，檢出栓子555個(gè)（肺動(dòng)脈主干26個(gè)，葉動(dòng)脈73個(gè)，肺段動(dòng)脈254個(gè)，亞段肺動(dòng)脈202個(gè)）。低年資醫(yī)生組檢出了81例肺栓塞患者中的67例，診斷敏感性為82.7%；檢出肺栓子493個(gè),敏感性為88.8%，在肺動(dòng)脈各級(jí)（肺動(dòng)脈主干、葉、段、亞段）的敏感性分別為100%（26/26）、98.6%(72/73)、89.8%(228/254)、82.7%(167/202)；“低年資醫(yī)生+CAD”組檢出了81例患者中的75例，診斷肺栓塞的敏感性為92.6%；檢出肺栓子523個(gè)，敏感性為94.2%，在肺動(dòng)脈各級(jí)（肺動(dòng)脈主干、葉、段、亞段）的敏感性分別為100%（26/26）、100%（73/73）、92.1%（234/254）、94.1%（190/202）；CAD正確判斷了81例中的67例，診斷敏感性為82.7%，共發(fā)現(xiàn)栓子305個(gè)，敏感性為55.0%，在肺動(dòng)脈各級(jí)（肺動(dòng)脈主干、葉、段、亞段）的敏感性為11.5%（3/26）、35.6%（26/73）、53.9%（137/254）、68.8%（139/202）。其中有6例患者低年資醫(yī)生最初判斷為陰性，但經(jīng)CAD輔助診斷后發(fā)現(xiàn)了栓子。結(jié)論： CAD技術(shù)可高度敏感的檢測(cè)出肺血管內(nèi)栓子，，低年資醫(yī)生與CAD相結(jié)合后提高了低年資醫(yī)生診斷肺栓塞的敏感性，尤其是在對(duì)亞段肺栓子的發(fā)現(xiàn)。同時(shí)CAD的診斷結(jié)果受圖像質(zhì)量影響較大，應(yīng)對(duì)CTPA圖像進(jìn)行嚴(yán)格控制。
[Abstract]:Objective: to evaluate the diagnostic value of (CAD) in pulmonary embolism in CT pulmonary angiography. Materials and methods: from July 2010 to December 2010, 279 patients with suspected pulmonary embolism or deep venous thrombosis of lower extremity underwent CTPA examination. Three senior radiologists (8, 10, 15 years of chest radiology, respectively) evaluated all patients and made consistent diagnoses as a reference standard. All patients were assessed by two inexperienced and junior doctors, and the location, number, and data of the embolus were recorded as data for the group of junior doctors. Three months later, Then the two junior doctors re-evaluated the above patients. This time, the location and number of emboli were also recorded by (CAD),. The obtained data were recorded by the senior physician as the data of the CAD group. The accuracy of diagnosis of pulmonary embolism was evaluated by comparing the number of patients with embolus and the number of emboli in the junior doctor group, the "junior doctor CAD" group and the CAD group. SPSS11.5 software package was used for statistical analysis. The frequency analysis was used for descriptive data, the X2 test was used for the comparison between groups, the difference was P < 0. 05, and the Kappa test was used for consistency comparison among groups. Results: 267 patients were included in the study. Among the 267 patients, 81 cases were diagnosed by 3 senior doctors, and 555 emboli were detected (26 main pulmonary arteries, 73 lobar arteries, 254 segmental pulmonary arteries and 202 subsegmental pulmonary arteries). 67 out of 81 patients with pulmonary embolism were detected in the junior doctor group, the diagnostic sensitivity was 82.7%, 493 pulmonary emboli were detected and the sensitivity was 88.8. The sensitivity was 100% (26 / 26), 98.6% (72 / 73) and 82.7% (16.7 / 202) at all levels of pulmonary artery (pulmonary artery trunk, lobe, segment, subsegment), respectively. In the CAD group, 75 of the 81 patients were diagnosed with pulmonary embolism, the sensitivity of diagnosis was 92.62.The sensitivity of detecting pulmonary emboli was 94.22%, and the sensitivity of pulmonary artery was 100% (26 / 26), 100% (73 / 73) and 94.1% (234254) / 94.1% (190-202) at all levels of pulmonary artery (main pulmonary artery, lobe, segment, subsegment), respectively. CAD correctly diagnosed 67 out of 81 patients, with a diagnostic sensitivity of 82.7. 305 emboli were found and the sensitivity was 55.0. The sensitivity was 11.5% (3 / 26), 35.6% (26 / 73), 53.9% (137254) and 68.8% (139r202) at all levels of pulmonary artery (trunk, lobe, segment, subsegmentof pulmonary artery). Six of them were diagnosed as negative at first, but embolus was found by CAD assistant diagnosis. Conclusion: CAD technique can be used to detect intravascular embolism of lung, and the combination of CAD and junior doctors can improve the sensitivity of diagnosis of pulmonary embolism, especially in the detection of subsegmental pulmonary embolism. At the same time, the diagnosis result of CAD is greatly affected by the image quality, so the CTPA image should be strictly controlled.
【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R563.5

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