CAJ | 학술논문

目的：建立慢性血栓栓塞性肺动脉高压（CTEPH）的动物模型，评价双能量CT（DECT）肺动脉成像检测CTEPH的准确性。方法18只实验犬每隔2周重复穿刺、栓塞、扫描、测压及喂食氨甲环酸，直到收缩压/舒张压>30/15 mmHg(1 mmHg=0.133 kPa)或肺动脉平均压>20 mmHg行DECT，然后处死行病理检查。以每只犬及肺叶为单位，以病理结果为参照分析DECT扫描所得常规CT肺动脉成像（CTPA）和DECT灌注成像显示肺栓塞的数目、位置，并计算其检测CTEPH的敏感度、特异度、准确性。利用配对χ2检验（McNemar检验）分析CTPA与DECT灌注成像检测CTEPH的差异。利用Kappa检验分别计算医师间CTPA及DECT分析肺栓塞的一致性。结果5只犬在首次实验栓子注入后急速死亡被排除，13只犬均成功制成CTEPH模型。以每只犬为分析单位，2名医师利用DECT均发现11只犬（84.6%，11/13）两肺不均匀灌注缺损，常规CTPA仅发现5只犬（38.5%，5/13）肺动脉截断或突然变窄。以肺叶为分析单位，2名医师分别利用CTPA及DECT灌注成像检测CTEPH的敏感度、特异度、准确性分别为14.3%（5/35）、83.3%（30/36），100.0%（30/30）、100.0%（29/29），53.8%（35/65）、90.8%（59/65），DECT灌注成像检测CTEPH的敏感度（χ2=-4.690，P<0.01）和准确性（χ2=8.284，P<0.01）均高于CTPA。CTPA医师间一致性非常好（Kappa=0.938，P<0.01），DECT医师间一致性中等（Kappa=0.537，P<0.01）。结论利用自制自体血栓反复栓塞制备家犬CTEPH模型是可行的；与常规CTPA相比，DECT灌注成像对于CTEPH检测的准确性更高。
목적：건립만성혈전전새성폐동맥고압（CTEPH）적동물모형，평개쌍능량CT（DECT）폐동맥성상검측CTEPH적준학성。방법18지실험견매격2주중복천자、전새、소묘、측압급위식안갑배산，직도수축압/서장압>30/15 mmHg(1 mmHg=0.133 kPa)혹폐동맥평균압>20 mmHg행DECT，연후처사행병리검사。이매지견급폐협위단위，이병리결과위삼조분석DECT소묘소득상규CT폐동맥성상（CTPA）화DECT관주성상현시폐전새적수목、위치，병계산기검측CTEPH적민감도、특이도、준학성。이용배대χ2검험（McNemar검험）분석CTPA여DECT관주성상검측CTEPH적차이。이용Kappa검험분별계산의사간CTPA급DECT분석폐전새적일치성。결과5지견재수차실험전자주입후급속사망피배제，13지견균성공제성CTEPH모형。이매지견위분석단위，2명의사이용DECT균발현11지견（84.6%，11/13）량폐불균균관주결손，상규CTPA부발현5지견（38.5%，5/13）폐동맥절단혹돌연변착。이폐협위분석단위，2명의사분별이용CTPA급DECT관주성상검측CTEPH적민감도、특이도、준학성분별위14.3%（5/35）、83.3%（30/36），100.0%（30/30）、100.0%（29/29），53.8%（35/65）、90.8%（59/65），DECT관주성상검측CTEPH적민감도（χ2=-4.690，P<0.01）화준학성（χ2=8.284，P<0.01）균고우CTPA。CTPA의사간일치성비상호（Kappa=0.938，P<0.01），DECT의사간일치성중등（Kappa=0.537，P<0.01）。결론이용자제자체혈전반복전새제비가견CTEPH모형시가행적；여상규CTPA상비，DECT관주성상대우CTEPH검측적준학성경고。
Objective To establish the animal model of chronic thromboembolic pulmonary hypertension(CTEPH) and to compare the accuracy of dual-energy CT (DECT) pulmonary angiography and histopathology for detecting CTEPH. Methods Eighteen canines were included in the study. All canines underwent paracentesis, embolization, CT scanning, pressure measurement and tranexamic acid feeding. The procedures were repeated every two weeks, until systolic/diastolic pressure in canines was≥30/15 mmHg or mean pulmonary artery pressure ≥ 20 mmHg.And then canines were sacrificed for histopathology examination. For CT pulmonary angiography (CTPA)in DE mode and DECT lung perfused blood volume (Lung PBV) images, the presence or absence of PE or perfusion defects were recorded on a per-canineand aper-lobe basis. With histopathological results as reference standard, the sensitivity, specificity of CTPA and lung PBV to detect PE were computed for two readers. The pairedχ2 test (McNemar test) was used to analyze the difference in diagnostic accuracy between CTPA and Lung PBV. Inter-reader agreement was also calculated with kappa test. Results CTEPH was demonstrated in 13 canines. On a per-canine basis, both readers found uneven and peripheral perfusion defects with DECT in 11 canines (84.6%, 11/13); while 5 canines (38.5%, 5/13) had cutoff or sudden stenosis of pulmonary arteries with CTPA;on a per-lobe basis, <br> both readers had sensitivities of 14.3%(5/35), 83.3%(30/36), specificities of 100.0%(30/30), 100.0%(29/29), accuracies of 53.8%(35/65), 90.8%(59/65)for CTPA and DECT, respectively. DECT had a higher sensitivity(χ2=-4.690,P<0.01)and accuracy(χ2=8.284,P<0.01) in detecting CTEPH. Excellent and moderate inter-reader agreements were observed with CTPA and DECT (Kappa=0.938, 0.572, both P<0.001). Conclusions It is feasible to make a CTEPH animal model with autologous thrombus. DECT shows a higher accuracy than CTPA to detect CTEPH in this canine model study.