计算机断层肺动脉造影评估肺栓塞阳性率：2012年至2021年的变化趋势分析

The yield of computed tomography pulmonary angiography for pulmonary embolism: temporal trend from 2012 to 2021

摘要

目的 探讨计算机断层肺动脉造影(computed tomography pulmonary angiography, CTPA)检查中肺栓塞(pulmonary embolism, PE)阳性率随时间的变化趋势。方法 回顾性且连续性纳入2012年1月1日至2021年12月31日期间在西安交通大学第一附属医院因疑诊PE而行CTPA,且成功完成了检查的所有患者。通过数据清洗和对齐,分析CTPA检查结果,将患者分为PE阳性组和PE阴性组。以年为单位,逐年统计2012年至2021年期间的PE阳性例数和PE阴性例数,然后进行线性回归分析,得到CTPA检查例数线性增长的斜率、截距和95%可信区间(95% CI)。计算PE阳性率和CTPA检查年增长率。结果 相比于2012年,2021年的PE阳性例数增长了584.61%,年增长率最快是2017年至2018年,为59.42%；相比于2012年,2021年的PE阴性例数增长了1 870.88%,年增长率最快是2018年至2019年,为82.30%。2012年至2015年期间,PE的阳性率保持在40%左右；从2015年起至2021年,PE阳性率逐年下降,2021年降至18.65%。2012至2021年间CTPA检查中,PE阳性率最高的3个科室从高到低为妇产科(58.21%)、骨科(46.67%)、重症医学科(46.42%)；PE阳性率最低的3个科室从低到高为心内科(16.78%)、心脏和血管病科(29.64%)、老年科(30.77%)。心内科的PE阳性率最高的年份为2015年为34.88%,随后逐年下降,至2020年为12.20%,2021年仅为9.55%；急诊科PE阳性率最高在2014年,为84.00%,随后快速下降,至2021年降至18.03%。心内科和急诊科的PE阳性率的年度变化百分比(annual percent change, APC)的拐点分别在2015年和2017年。结论 CTPA的使用率明显增加,PE阳性率逐年下降,在心内科中PE阳性率低于10%,在急诊科下降速度最快,都需要引起重视。

Abstract

Objective To investigate the temporal trend in the positivity rate of pulmonary embolism (PE) on computed tomography pulmonary angiography (CTPA) examinations. Methods We retrospectively and consecutively enrolled all patients who underwent CTPA for suspected PE at The First Affiliated Hospital of Xi'an Jiaotong University between January 1, 2012, and December 31, 2021, and completed the examination. After data cleaning and alignment, the patients were categorized into PE-positive and PE-negative groups based on CTPA findings. The annual number of PE-positive and PE-negative cases from 2012 to 2021 was calculated. Linear regression analysis was performed to determine the slope, intercept, and 95% confidence interval (95% CI) for the linear growth in the number of CTPA examinations. The PE positivity rate and the annual growth rate of CTPA examinations were computed. Results Compared to 2012, the number of PE-positive cases in 2021 increased by 584.61%. The fastest annual growth rate occurred between 2017 and 2018, at a rate of 59.42%. Compared to 2012, the number of PE-negative cases in 2021 increased by 1 870.88%, with the fastest annual growth rate (82.30%) observed between 2018 and 2019. The PE positivity rate remained around 40% from 2012 to 2015. From 2015 onwards, the positivity rate declined annually, reaching 18.65% in 2021. Among all CTPA examinations performed between 2012 and 2021, the three departments with the highest PE positivity rates were Obstetrics and Gynecology Department (58.21%), Orthopedics Department (46.67%), and the Intensive Care Unit (46.42%). The three departments with the lowest PE positivity rates were Cardiology Department (16.78%), Cardiovascular Medicine Department (29.64%), and Geriatrics Department (30.77%). Within the Cardiology Department, the highest positivity rate was 34.88% in 2015, followed by a yearly decline to 12.20% in 2020 and only 9.55% in 2021. The Emergency Department had its highest positivity rate (84.00%) in 2014, which subsequently decreased rapidly to 18.03% by 2021. The inflection point of the annual percent change (APC) in the Cardiology Department and the Emergency Department was in 2015 and 2017, respectively. Conclusion The utilization of CTPA has significantly increased, while the PE positivity rate declines year by year. The notably low positivity rate, below 10%, in the Cardiology Department, and the rapid decline observed in the Emergency Department, warrant attention.

关键词

计算机断层肺动脉造影(CTPA) / 肺栓塞(PE) / 阳性率 / 年度变化百分比(APC)

Key words

computed tomography pulmonary angiography (CTPA) / pulmonary embolism (PE) / positivity rate / annual percent change (APC)

参考文献

[1] KONSTANTINIDES S V, MEYER G, BECATTINI C, et al. 2019 ESC guidelines for the diagnosis and management of acute pulmonary embolism were developed in collaboration with the European Respiratory Society (ERS)[J]. Eur Heart J, 2020, 41(4): 543-603.

[2] HOSKIN S, BRIEGER D, CHOW V, et al. Trends in acute pulmonary embolism admission rates and mortality outcomes in Australia, 2002—2003 to 2017—2018: a retrospective cohort study[J]. Thromb Haemost, 2021, 121(9): 1237-1245.

[3] RIVERA—LEBRON B, MCDANIEL M, AHRAR K, et al. Diagnosis, treatment and follow up of acute pulmonary embolism: consensus practice from the PERT consortium[J]. Clin Appl Thromb Hemost, 2019, 25: 1076029619853037.

[4] SCHMID J, NAGY E, KAUFMANN B A, et al. Diagnosing pulmonary embolism with computed tomography pulmonary angiography: diagnostic accuracy of a reduced scan range[J]. J Thorac Imaging, 2022, 37(5): 323-330.

[5] DISSAUX B, LE FLOCH P Y, ROBIN P, et al. Pulmonary perfusion by Iodine subtraction maps CT angiography in acute pulmonary embolism: comparison with pulmonary perfusion SPECT (PASEP trial)[J]. Eur Radiol, 2020, 30(9): 4857-4864.

[6] CRICHLOW A, CUKER A, MILLS A M. Overuse of computed tomography pulmonary angiography in the evaluation of patients with suspected pulmonary embolism in the emergency department[J]. Acad Emerg Med, 2012, 19(11): 1219-1226.

[7] PERERA M, AGGARWAL L, SCOTT I A, et al. Underuse of risk assessment and overuse of computed tomography pulmonary angiography in patients with suspected pulmonary thromboembolism[J]. Intern Med J, 2017, 47(10): 1154-1160.

[8] RICHARDSON S, SOLOMON P, O'CONNELL A, et al. A computerized method for measuring computed tomography pulmonary angiography yield in the emergency department: validation study[J]. JMIR Med Inform, 2018, 6(4): e44.

[9] KLINE J A, GARRETT J S, SARMIENTO E J, et al. Over—testing for suspected pulmonary embolism in American emergency departments: the continuing epidemic[J]. Circ Cardiovasc Qual Outcomes, 2020, 13(1): e005753.

[10] ZHAO Y, WANG H, ZHAO J, et al. Renal protective effect of sodium ferulate on pulmonary hypertension patients undergoing computed tomography pulmonary angiography[J]. Pulm Circ, 2020, 10(4): 2045894020903953.

[11] YAZICI S, KIRI T, EMRE A, et al. Relation of contrast nephropathy to adverse events in pulmonary emboli patients diagnosed with contrast CT[J]. Am J Emerg Med, 2016, 34(7): 1247-1250.

[12] SCHISSLER A J, ROZENSHTEIN A, KULON M E, et al. CT pulmonary angiography: increasingly diagnosing less severe pulmonary emboli[J]. PLoS One, 2013, 8(6): e65669.

[13] DE BOER H C, RAJARAM S, CHOPRA A, et al. 10,589 CT pulmonary angiograms: evaluating the yield of acute pulmonary embolism[J]. Br J Radiol, 2022, 95(1137): 20220254.

[14] YAGHOOBPOOR S, FATHI M, TAHER H J, et al. Computed tomography pulmonary angiography (CTPA) for the detection of pulmonary embolism (PE) among trauma patients: a systematic review and meta—analysis[J]. Emerg Radiol, 2024, 31(4): 567-580.

基金资助

陕西省重点研发计划资助项目(2025SF-YBXM-345)