【摘要】：目的：評價在CT肺血管造影檢查中，計算機輔助檢測（CAD）技術(shù)診斷肺栓塞的價值。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）對所有患者進行評估，做出的一致性診斷作為參考標準。先由兩位缺乏經(jīng)驗的低年資醫(yī)生對所有患者共同進行評估，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個月后，再由這兩位低年資醫(yī)生對以上患者重新進行評估，這次借助計算機輔助檢測（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)生進行記錄。分別從患者數(shù)和栓子數(shù)兩個方面進行比較，評價低年資醫(yī)生組、“低年資醫(yī)生+CAD”組和CAD組診斷肺栓塞的準確性。統(tǒng)計分析采用SPSS11.5統(tǒng)計軟件包。描述性資料采用頻數(shù)分析法；組間比較采用X2檢驗，以P＜0.05為差異有統(tǒng)計學意義；組間一致性比較采用Kappa檢驗。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（肺動脈主干26個，葉動脈73個，肺段動脈254個，亞段肺動脈202個）。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,敏感性為88.8%，在肺動脈各級（肺動脈主干、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，敏感性為94.2%，在肺動脈各級（肺動脈主干、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，敏感性為55.0%，在肺動脈各級（肺動脈主干、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，尤其是在對亞段肺栓子的發(fā)現(xiàn)。同時CAD的診斷結(jié)果受圖像質(zhì)量影響較大，應對CTPA圖像進行嚴格控制。
[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.
【學位授予單位】：寧夏醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R563.5

【參考文獻】

相關(guān)期刊論文 前10條

1 周艷君;多普勒超聲在急性肺栓塞診斷與療效評估中的應用[J];中國超聲診斷雜志;2005年04期

2 莫朝暉,朱文輝,李冰,劉競;糖尿病患者血漿D-二聚體的變化及其與血管病變的關(guān)系[J];中國醫(yī)師雜志;2003年01期

3 邢欣來;何中市;王健;;組合分類器輔助診斷肺栓塞的研究[J];計算機工程與應用;2009年12期

4 朱力;郭玉林;田興倉;來彥博;龔瑞;;不同層厚的CTPA圖像對正常肺動脈分支的顯示[J];寧夏醫(yī)學雜志;2009年11期

5 楊凱,江泓,談旭東;雙能量減影及其臨床應用[J];實用放射學雜志;2004年11期

6 葛雅麗;葛雪松;鄭敏文;張勁松;劉瑩;劉燕麗;徐鍵;楊勇;趙海濤;宦怡;;肺栓塞的磁共振成像技術(shù)應用研究[J];實用放射學雜志;2006年11期

7 包尚聯(lián),謝耀欽,周曉東,陳國躍;基于醫(yī)學影像計算機輔助診斷的分割方法[J];中國醫(yī)學物理學雜志;2003年02期

8 孫兵,王辰;肺血栓栓塞癥診斷策略[J];中華醫(yī)學信息導報;2003年21期

9 繆競陶,朱培菊,張尚福,何之彥,周清華;肺癌侵犯肺靜脈干的CT、MRI表現(xiàn)及與病理的相關(guān)性研究[J];中華放射學雜志;1997年01期

10 ;肺血栓栓塞癥的診斷與治療指南(草案)[J];中華結(jié)核和呼吸雜志;2001年05期

本文編號：2204453