Abstract
Aim: To compare the diagnostic performance of
chest sonography, MRI angiography and ventilation/perfusion intigraphy in
pulmonary embolism (PE). Method: In a prospective
clinical study, 55 patients (41 women, 14 men, age 23 - 91
years) with clinical signs of PE were investigated within 48 hours of the onset
of symptoms. The final diagnosis was made by MRI angiography (reference
method). Results: PE was diagnosed in a total of 36
patients. Chest sonography revealed rounded or wedge-shaped hypoechoic lesions
in 30 patients. On ventilation/perfusion (V/P) scintigraphy, 41 patients had
positive V/P scans, but only 23 were of high probability. Chest ultrasound had
a positive predictive value of 97 % to diagnose PE. The
sensitivity, specificity, the negative predictive value and accuracy were
81 %, 84 %, 84 % and
82 %, respectively. As 18 patients had inconclusive scans, the
diagnostic performance of ventilation/perfusion scintigraphy was poor. The
positive predictive value, sensitivity and specificity were 58 %,
42 % and 91 %, respectively. Patients in whom PE
was excluded mainly suffered from congestive heart failure, bronchopulmonary
infections or pulmonary hypertension. Conclusion: A
negative sonographic study cannot rule out PE with certainty. However, a chest
sonography is of acceptable diagnostic value in patients with suspected PE and
may be used as an adjunct or guide to more established methods.
Zusammenfassung
Studienziel: Ermittlung der diagnostischen
Wertigkeit der Lungensonographie im Vergleich zur MR-Angiographie und
Lungenszintigraphie bei Patienten mit Verdacht auf Pulmonalembolie (PE).
Methode : In einer prospektiven Studie wurden 55
Patienten mit klinischem Verdacht auf Lungenembolie innerhalb von 48 Stunden
nach Auftreten der Symptome mit den verschiedenen Methoden untersucht. Die
endgültige Diagnose einer PE wurde durch die MR-Angiographie
(Referenzmethode) gestellt. Ergebnisse: Bei 36 Patienten
wurde eine PE diagnostiziert. In der Lungensonographie wurden bei 30 Patienten
rundliche oder keilförmige echoarme Läsionen gefunden, während
in der Lungenszintigraphie 41 positive Befunde, jedoch nur 23 mit hoher
Emboliewahrscheinlichkeit gesehen wurden. Die Lungensonographie wies mit
97 % vs. 91 % eine höhere positive
Vorhersagewahrscheinlichkeit gegenüber der Lungenszintigraphie auf.
Sensitivität (81 % vs. 58 %), Spezifität
(84 % vs. 42 %), negative
Vorhersagewahrscheinlichkeit (84 % vs. 57 %) und
Treffsicherheit (82 % vs. 53 %) waren aufgrund von
18 inkonklusiven Szintigrammen ebenfalls zugunsten der Lungensonographie.
Patienten, bei denen eine PE ausgeschlossen wurde, litten überwiegend an
Herzinsuffizienz, bronchopulmonalen Infekten und pulmonaler Hypertonie.
Schlussfolgerung: Obwohl mit der Lungensonographie ein
sicherer Ausschluss einer PE nicht möglich ist, hat sie eine akzeptable
diagnostische Wertigkeit bei Verdacht auf PE. Sie kann zusätzlich oder als
Wegweiser für etablierte Methoden eingesetzt werden.
Key words
Pulmonary embolism - diagnosis - sonography - MRI angiography
Schlüsselwörter
Lungenembolie - Diagnose - Ultraschall - MR-Angiografie
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Univ.-Prof. Dr. P. Lechleitner
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