Diagnosis Of Pulmonary Embolism By 64-Detector MDCT Combined With Doppler Ultrasonography And Indirect CTV Of The Leg: A Different Protocol

Year 2013, Volume: 10 Issue: 1, 7 - 13, 01.03.2013

Alaaddin Nayman Kemal Odev

Abstract

The aim of our study was to investigate the contribution of CT angiography in cases with a presumptive PTE diagnosis, evaluating lower extremity veins with CT venography and color Doppler ultrasonography (CDU) and the role of these methods at diagnosis of DVT. 46 patients with presumptive diagnosis of PTE which was confirmed with a positive CT angiography (CTA) were included in the study. Lower extremities between the iliac crest and head of femur and the popliteal region were scanned having 17-18 slices from each area, without administring extra contrast medium with a 0.8 mm slice gap. The patients underwent lower extremity CDU on the same day. Four out of 46 patients were shown to have thrombus by CDU while their CTV were normal. Two of them had an appearance of thrombus on CTV while their CDU were normal. When we consider CDU as the gold standard method, the sensitivity of CTV is calculated as 81.8% and the specificity as 91.6%. Kappa value between two modalities was calculated as 0.738 and a consistency of 87% is found. Mean radiation dose was calculated as 2.43 mSv for CTA and 0.457 mSv for CTV. With the imaging technique so-called combined CTA-indirect CTV method, DVT can be determined with moderate sensitivity and high specificity with application of low dose extra radiation.

Keywords

Pulmonary Thromboembolism, MDCT, pulmonary CT angiography, indirect CT venography, color doppler ultrasonography

Diagnosis Of Pulmonary Embolism By 64-Detector MDCT Combined With Doppler Ultrasonography And Indirect CTV Of The Leg: A Different Protocol

Abstract

Pulmoner tromboemboli (PTE) sık görülmekle birlikte tanısındaki gecikme nedeniyle mortalitesi yüksek bir hastalıktır. PTE ve alt ekstremite derin ven trombozu (DVT) aynı patolojik sürecin iki parçası olmakla birlikte PTE’ nin %90 nedenini alt ekstremite DVT oluşturmaktadır. Bu çalışmanın amacı pulmoner BT anjiografide (BTA) PTE tespit edilen olgularda, alt ekstremite derin venlerinin indirekt BT venografi (BTV) ve RDUS ile değerlendirilmesi ve son iki incelemenin DVT tanısındaki yerini araştırmaktır. Prospektif olarak, Haziran 2009 ve mayıs 2010 tarihleri arasında, ön tanısında PTE olan ve pulmoner BTA’ de PTE tespit edilen 46 hasta çalışmaya dahil edildi. Pulmoner BTA sonrasında indirekt BTV incelemesi ayrı iki bölge (iliak krestler-femur başı arası ve popliteal bölge) alınarak, ek kontrast madde verilmeden yapıldı. Hastalar aynı gün içinde alt ekstremite venlerine yönelik renkli doppler ultrasonografi (RDUS) ile değerlendirildi. Hastaların aldığı radyasyon dozları hesaplandı. Çalışma dahilindeki 22 erkek (ortalama yaş: 48,7) ve 24 kadın (ortalama yaş: 63,4) toplam 46 hastanın tümünde PTE vardı. 46 hastanın 22’ sinde RDUS’ de DVT saptanmış olup 4 hastada RDUS’ de trombüs varken BTV normaldi. 2 hastada da RDUS normal iken BTV’ de trombüs görünümü vardı. RDUS altın standart kabul edildiğinde indirekt BTV’nin duyarlılığı: %81.8 seçiciliği: %91.6 olarak hesaplandı. İki tetkik arasında Kappa değeri: 0.738 olarak hesaplandı ve %87 tutarlılık olduğu saptandı. BTA çekimi için hastanın aldığı ortalama radyasyon dozu 2.43 mSv, indirekt BTV için verilen ek radyasyon dozu ise 0.457 mSv olarak hesaplandı. Kombine BTA-indirekt BTV yöntemi olarak adlandırılan inceleme tekniğinde çok yüksek duyarlılıkta olmasa bile yüksek seçicilik oranında, düşük dozda ek radyasyon verilerek DVT saptanabilmektedir

Keywords

Pulmoner tromboembolizm, MDBT, pulmoner BT anjiografi, indirekt BT venografi, renkli dopler ultrasonografi

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