多层螺旋 CT 肺动脉造影对急性肺栓塞右心功能相关参数的可重复性研究

摘要

Objective To evaluate the repeatability of multislice CT pulmonary artery angiography ( MSCTPA ) in diagnosis of related right ventricular parameters in patients with acute pulmonary embolism ( PE) by different observers or in different time points.Methods The clinical data about 50 patients with PE who underwent MSCTPA in our hospital from January 2013 to November 2014 were retrospectively analyzed.The CT-related right ventricular parameters were quantitatively analyzed,including interventricular septum location, inferior vena cava ( IVC ) reflux, ratio of RV diameter ( RVD )/left ventricular diameter (LVD) on axial sections and four-chamber (4-CH) views, and ratio of right and left ventricular area ( RVA/LVA) on four-chamber section.The results were statistically analyzed by using kappa statistics, Pearson coefficient of rank correlation and Bland-Altman analysis.Results The consistency was better in septal position (κ=0.754) and the vena cava reflux (κ=0.865) detected by the same observer in two-time detections.Pearson analysis showed that the correlation coefficient of RVD-ax/LVD-ax, RVD-4ch/LVD-4ch and RVA/LVA in two time points was 0.959, 0.932 and 0.987, respectively ( P <0.01).The consistency was acceptable in septal position (κ=0.384) and vena cava reflux (κ=0.503) detected by different observers.Pearson analysis also showed that the correlation coefficient of RVD-ax/LVD-ax,RVD-4ch/LVD-4ch and RVA/LVA detected by two testers was 0.556,0.652,0.793 ( P <0.01).Conclusion The consistency is better in repeat measure of CT-related right ventricular parameters in patients with PE detected by the same observer, however, the measure results detected by different observers are quite different.The ratio of RVA/LVA is relatively objective index to evaluate right ventricular function of patients with PE.%目的：评价不同观察者间及同一观察者在不同时间对肺栓塞患者CT相关右心功能参数定量测量的可重复性。方法回顾性分析行多层螺旋CT肺动脉成像且影像质量良好的肺栓塞患者50例，对肺动脉栓塞患者CT有关右心室的相关参数进行定量评价，包括：室间隔位置、腔静脉回流、轴位及四腔层面右、左心室内径比（ RVD／LVD）、四腔心层面右、左心室截面积比（ RVA／LVA）。统计分析使用kappa统计、Pearson等级相关系数和Bland-Alt-man分析。结果同一观察者前、后2次测量室间隔位置（κ＝0 X．754）及腔静脉返流（κ＝0．865）一致性较好。 Pearson分析前、后2次测量 RVD-ax／LVD-ax、RVD-4ch／LVD-4ch、RVA／LVA间相关系数分别为0．959、0．932、0．987（ P ＝0．000）。不同观察者测量室间隔位置（κ＝0．384）及腔静脉返流（κ＝0．503）一致性尚可。 Pearson 分析二人测量RVD-ax／LVD-ax、RVD-4ch／LVD-4ch、RVA／LVA间相关系数分别为0．556、0．652、0．793（ P ＝0．000）。结论同一观察者对急性肺栓塞患者右心功能参数的重复测量一致性较好；而不同观察者间测量结果存在较大差异。采用左、右室截面积比是诊断肺动脉栓塞右心室功能较客观的指标。