Risk-BenefitAnalysisofPulmonaryCTAngiographyinPatientsWithSuspectedPulmonaryEmbolus
AJRAmJRoentgenol.Jun;(6):-9
JamesK.H.Woo1RitaY.W.ChiuYogeshThakurJohnR.Mayo
1Allauthors:DepartmentofRadiology,VancouverGeneralHospital,W12thAve,Vancouver,BCV5Z1M9,Canada.AddresscorrespondencetoJ.R.Mayo(john.mayo
vch.ca).OBJECTIVETheobjectiveofourstudywastoestimatethemortalitybenefit-to-riskratioofpulmonaryCTangiography(CTA)bysetting(ambulatory[emergencydepartmentoroutpatient]orinpatient),age,andsex.
MATERIALSANDMETHODSAretrospectiveevaluationofconsecutivepulmonaryCTAexaminationswasperformedandthefollowinginformationwasrecorded:examinationsetting,patientage,patientsex,pulmonaryCTAinterpretationforpulmonaryembolus(PE),andCTradiationexposure(dose-lengthproduct).WeestimatedmortalitybenefitofpulmonaryCTAbymultiplyingtherateofpositivepulmonaryCTAexaminationsbypublishedestimatesofmortalityofuntreatedPEinambulatoryandinpatientsettings.WeestimatedthelifetimeattributableriskofcancermortalityduetoradiationfrompulmonaryCTAbycalculatingtheestimatedeffectivedoseandusingsex-specificpolynomialequationsderivedfromtheBiologicalEffectsofIonizingRadiationVIIreport.Wecalculatedbenefit-toriskratiosbydividingthemortalitybenefitofpreventingafatalPEbythemortalityriskofaradiation-inducedcancer.
RESULTSPulmonaryCTAdiagnosedPEinofpatients(13.2%).Bothinpatients(/,14.0%)andemergencydepartmentpatients(74/,14.5%)hadsignificantlyhigherratesofPEthanoutpatients(13/[6.8%]).Malesreceivedsignificantly(p=0.)higherradiationdose(9.7mSv)thanfemales(8.4mSv),butmaleshadasignificantly(p0.)lowerlifetimeattributableriskofcancermortalitythanfemales.AssuminganuntreatedPEmortalityrateof5%forambulatorypatientsand30%forinpatients,thebenefitto-riskratiorangedfrom25forambulatorypatientstoforinpatients.Ambulatorywomenhadthelowestbenefit-to-riskratio.
CONCLUSIONThebenefit-to-riskratioofpulmonaryCTAinpatientswithsuspectedPErangesfrom25toandcanbeincreasedbyoptimizingtheradiationdose.
可疑肺栓塞患者的肺动脉CTA风险-获益分析
医院放射科王振译
医院放射科杨敏洁校
目的：我们研究的目的是通过检查环境（流动病例[急诊科或门诊患者]或住院患者），年龄，性别等因素评估肺动脉CTA的死亡率获益-风险比。
材料和方法：回顾性评价例连续肺动脉CTA检查并记录下列随访信息：检查环境、患者年龄、患者性别、肺栓塞的CTA报告和CT辐射剂量（剂量长度乘积，DLP）。我们通过肺动脉CTA检查阳性率乘以文献报道的未经治疗的流动和住院肺栓塞患者的预估死亡率来评估肺动脉CTA死亡率获益。我们通过计算预估有效剂量和从第七版《电离辐射生物效应》(BEIRVII)报告导出的性别特定多项式公式来评估肺动脉CTA检查导致的终生致癌风险病死率。我们通过预防致死性肺栓塞的病死率获益除以辐射介导癌症的病死率风险来计算获益-风险比。
结果：例患者中，例肺动脉CTA诊断为肺栓塞（13.2%）。住院患者(/,14.0%)和急诊科患者(74/,14.5%)的肺栓塞患病率明显高于门诊患者(13/,6.8%)。男性(9.7mSv)比女性(8.4mSv)接受更高的辐射剂量(p=0.)，但终生致癌风险病死率明显低于女性(p0.)。假设流动患者及住院患者的未治疗肺栓塞病死率分别为5%及30%，则两者的获益-风险比分别为25及。流动女性患者的获益-风险比最低。
结论：可疑肺栓塞患者的肺动脉CTA风险-获益比范围为25-，通过优化辐射剂量可增加风险-获益比。
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