CTPA在诊断肺动脉血栓栓塞症中的临床价值研究

目的 探讨螺旋CT肺动脉造影(Computed tomography pulmonary angiography,CTPA)在诊断肺动脉血栓栓塞症(PTE)中的临床应用价值.方法 回顾性分析2006年7月至2008年10月经CTPA诊断的8例肺动脉血栓栓塞患者的CT征像.结果 8例经CTPA确诊的PIE病例,共累及86支肺动脉(51.1%).受累肺动脉位于右肺56支(65.1%),肺段动脉受累58支(67.4%).栓子形态包括完全充盈缺损16支,中心充盈缺损18支,偏心性部分充盈缺损39支,附壁充盈缺损13支.PE的间接征象主要包括肺动脉高压、肺梗死灶形成、胸腔积液和支气管动脉扩张等.结论 螺旋CT进行CTPA检查具有快捷、无创、安全等特点,是诊断肺动脉血栓栓塞症(FIE)的首选检查.     

急性肺栓塞的诊断现状分析及诊断策略研究

目的　分析 10年来我院急性肺栓塞 ( PE)的诊断现状并寻找 PE的有效诊断策略。方法　对10年来确诊 PE的患者资料进行分析统计 ,对近 5个月在急诊科就诊的患者利用临床评价联合肺通气 /灌注扫描和 (或 )螺旋 CT这一新的诊断策略来确诊或排除 PE。所有患者随访 3个月。结果　利用新诊断策略后PE的诊断率、3d确诊率、由肺扫描和 (或 )螺旋 CT确诊的比例均明显提高。应用新诊断策略后 ,需要行肺动脉造影检查的比例和 PE新发生率分别是 2 .8%和 0。结论　临床评价联合肺扫描和 (或 )螺旋 CT是诊断 PE的一项有效诊断策略     

MSCT肺动脉成像在肺动脉栓塞诊断中的应用价值

目的探讨多层螺旋CT(MSCT)肺动脉造影在肺动脉栓塞(PE)诊断中的应用价值。方法选取2016年2月至2017年9月在我院治疗的肺动脉栓塞患者62例,均经数字减影血管造影(DSA)检查确诊,所有均采用MSCT和MRI检查,比较两种方法的诊断情况。结果 62例患者经DSA检查确诊共有血管栓子97个,主要分布于肺主动脉、左肺动脉干和右肺动脉干,分别占25.77%、15.46%和18.56%;MSCT检查PE诊断率和栓子诊断率分别为93.55%和94.85%,明显高于MRI检查,差异比较有统计学意义(P0.05);MSCT和MRI检出马赛克征、心包积液或胸腔积液、肺段梗死和局限性肺纹理稀疏等PE间接征象比例差异比较无统计学意义(P0.05);62例患者中MSCT肺动脉栓塞指数为(32.18±5.44),RVd为(4.45±0.84)cm,LVd(4.13±0.75)cm,RVd/LVd为(1.32±0.43),肺动脉栓塞指数与RVd和RVd/LVd呈正相关(r=0.873和0.886,P0.05),与LVd呈负相关(r=-0.845,P0.05)。结论 MSCT肺动脉成像在肺动脉栓塞诊断中具有较好的应用价值,其肺动脉栓塞指数与右心功能参数有一定关系。     

螺旋CT对诊断肺动脉栓塞的价值

目的探讨螺旋CT对诊断肺动脉栓塞（PE）的价值。方法回顾性分析临床确诊为PE的57例患者的螺旋CT资料,包括螺旋CT平扫、肺动脉造影（SCTPA）。结果 57例PE病例,共累及246处肺动脉及其分支,57例均能较准确、全面显示栓子的位置、形态、范围和程度。结论螺旋CT对诊断PE具有重要价值,是及早发现PE并确诊的可靠的重要的检查手段之一。     

经胸超声心动图在肺动脉栓塞诊断中的应用价值

目的 探讨经胸超声心动图(TTE)对肺动脉栓塞(PE)的诊断价值.方法 分析18例确诊为PE患者的超声心动图表现,与增强CT、肺动脉造影对照.结果 超声心动图直接检出主肺动脉及左右肺动脉近段血栓者4例,右室内血栓1例;具有右心负荷过重超声征象者15例,增强CT或肺动脉造影确诊为PE;TTE大致正常者3例,CT或肺动脉造影提示为肺段或亚段栓塞.结果 TTE可发现主肺动脉、左右肺动脉干内血栓直接提示PE,或根据右心负荷过重表现并结合临床表现间接提示PE可能,但对肺段或亚段栓塞TTTE不能作出或排除诊断.     

16层螺旋CT对肺栓塞诊断价值的探讨

目的 探讨16层螺旋CT诊断肺动脉栓塞(pulmonary embolism,PE)的价值.方法 回顾性分析20例因临床高度怀疑肺栓塞患者的影像资料(16层螺旋CT平扫及肺血管造影增强扫描).结果 在20例患者中,20例中,13例螺旋CT血管造影(MSCTPA)发现有PE.确诊为PE的13例患者中有6例CT平扫即有阳性发现,其征象有局部肺纹理稀疏纤细、肺动脉扩张、"马赛克"征、胸腔积液或心包积液、肺动脉局限性密度增高、肺梗死灶.结论 MSCTPA诊断PE简便、安全、准确性高,是诊断PE的一种可靠性方法 ,但对于不能使用对比剂或因非典型心肺症状而仅作平扫的病例,16层螺旋CT平扫异常征象能提示PE的存在.     

应用多层螺旋CT血管造影诊断肺动脉栓塞的护理配合

目的探讨应用多层螺旋CT血管造影诊断肺动脉栓塞(PE)的护理配合．方法选择在我院应用多层螺旋CT血管造影诊断肺动脉栓塞的患41例，对护理配合进行回顾性分析。结果41例中确诊有PE17例，排除PE24例。结论正确合理的护理配合是保证多层螺旋CT血管造影成功的关键。     

螺旋CT肺动脉造影诊断急性肺动脉栓塞的研究

目的：探讨螺旋CT诊断急性肺动脉栓塞（PE）的方法与价值。材料与方法：回顾性分析249例临床怀疑急性PE的病人资料,探讨螺旋CT肺动脉造影（SCTPA）方法及PE表现特征。结果：测得主肺动脉干强化峰值时间约10.8s;经SCTPA共检出68例PE,发生栓塞的肺动脉705支,其中偏心型506支,占71.8%,中心型147支,占20.8%,附壁型33支,占4.7%,全堵型最少,为19支,占2.7%;181例未发现确切PE征象,但其中105例检出其它疾病。结论：SCTPA是诊断急性PE的重要方法,能较准确地诊断肺内其它病变,对于临床怀疑急性PE的就诊者,SCTPA应作为首选检查。     

双螺旋CT诊断肺动脉栓塞的临床研究

目的：评价双螺旋CT在诊断肺动脉栓塞（pulmonary embolism;PE)中的价值,着重研究小肺动脉栓塞及大肺动脉内的细小栓子的显示方法和诊断依据。方法：对39例临床拟诊为PE的患者,进行双螺旋CT肺动脉造影（DSCTPA）检查,且全部病例均经随诊证实。结果：中央型PE15例,周围型PE19例。检出PE的直接征象392处,间接征象51例。DSCTPA诊断周围型PE的敏感性为95％,特异性为75％。结论;双螺旋CT作为一种无创的检查方法,对诊断肺动脉栓塞可靠,能够明显提高小肺动脉栓塞的检出率。     

肺栓塞临床和影像学特征及危险因素分析

目的:探讨肺栓塞(PE)患者的临床和影像学特征及危险因素,提高诊治水平.方法:回顾性分析58 例PE住院患者的临床资料,对临床表现、肺影像学、危险因素等方面进行分析.结果:PE的误诊率高达62.07%,最易误诊为肺炎,其次为心肌梗死.老年组危险因素依次为下肢静脉血栓(DVT)、慢性阻塞性肺病(COPD)、心脏病、恶性肿瘤、长期制动;非老年组危险因素依次为结缔组织病、手术史、DVT、糖尿病、慢性肾病、肿瘤.PE以右肺动脉受累多见,占受累总数的65.8%.CT肺动脉造影(CTPA)分析:急性血栓形态:以中央型为多见,38例(占65.5%),其特征性改变包括轨道征、漂浮征等;慢性血栓形态:以附壁型为多见,20例(占35.5%),血栓钙化为其特有征象.CTPA对PE的诊断具有较高的敏感性(达85.5%),联合超声心动图检查可提高确诊率(达94.8%).结论:PE临床表现复杂多样不典型,CTPA 是首要的无创检查方法,可初步鉴别急性或慢性血栓,联合超声心动图检查可提高确诊率.     

肺栓塞36例急诊误诊临床分析

目的提高急诊科医生对肺血栓栓塞（pulmonary thromboembolism,FFE）的认识,探索急诊可行的PrE诊断程序．以提高本病早期确诊率。方法回顾性分析近5年来我院急诊误诊的36例FTE的临床资料,并进行改良Geneva评分评估临床诊断可能性。结果本组36例误诊为心血管疾病25例（69．4％）,误诊为其他呼吸系统疾病9例（25％）,误诊为脑血管疾病2例（5．6％）,其中30例（83．3％）有易患因素。进行改良Geneva评分显示FFE中度可能性26例,低度可能性10例。查D-二聚体36例均升高,后经螺旋CT肺动脉造影（CTPA）确诊32例、肺通气灌注扫描确诊4例,均予抗凝治疗好转出院。结论PTE临床易误漏诊,急诊科医生应加强对奉病的认识,接诊PTE疑诊患者应洵刚有尤易患因索,通过改良Geneva评分进行诊断可能性评估,结合血D-二聚体检测,必要时臼丁行CTFA等,以提高确诊率。     

增强与非增强MR肺动脉血管成像诊断肺栓塞准确性的对比研究

目的比较对比增强MR血管成像(contrast-enhanced MR pulmonary angiography,CE-MRA)与非增强空间标记多反转脉冲序列(applying spatial labeling with multiple inversion pulses sequence,SLEEK)MR血管成像诊断肺栓塞(pulmonary embolism,PE)的准确性。材料与方法 26例CT肺动脉血管成像诊断肺栓塞的患者(男15例,女11例)于多排螺旋CT肺动脉造影(CT pulmonary angiography,CTPA)检查48 h内行CE-MRA以及非增强SLEEK MR检查。CTPA作为参考标准,计算并比较每种MR技术诊断肺栓塞的敏感性、特异性、阳性预测值以及阴性预测值。结果 CE-MRA诊断肺栓塞的敏感性为78.8%,特异性97.7%。非增强SLEEK MRI诊断肺栓塞的敏感性83.8%,特异性100%。两阅片者间存在高度一致性(k=0.87)。结论 CE-MRA和SLEEK MRI诊断肺栓塞的准确性无统计学差异,但非增强SLEEK MRI血管成像无需使用对比剂,有希望成为肺栓塞诊断策略中的一部分。     

Diagnostic management of clinically suspected acute pulmonary embolism

Summary.  Current diagnostic management of hemodynamically stable patients with clinically suspected acute pulmonary embolism (PE) consists of the accurate and rapid distinction between the approximate 20–25% of patients who have acute PE and require anticoagulant treatment, and the overall majority of patients who do not have the disease in question. Clinical outcome studies have demonstrated that, using algorithms with sequential diagnostic tests, PE can be safely ruled out in patients with a clinical probability indicating PE to be unlikely and a normal D-dimer test result. This obviates the need for additional radiological imaging tests in 20–40% of patients. CT pulmonary angiography (CTPA) has become the first line tool to confirm or exclude the diagnosis of PE in patients with a likely probability of PE or an elevated D-dimer blood concentration. While single-row-detector technology CTPA has a low sensitivity for PE and bilateral compression ultrasound (CUS) of the lower limbs is considered necessary to rule out PE, multi-row-detector CTPA is safe to exclude PE without the confirmatory use of CUS.     

CTPA与V/Q扫描诊断肺栓塞的比较研究

目的以肺动脉造影为金标准,评价CT血管造影(CTPA)和肺通气灌注扫描(V/Q扫描)对肺栓塞的临床诊断价值.方法检索Cochrane图书馆、PubMed、Ovid数据库和中国期刊网中关于CTPA诊断肺栓塞的中英文文献,按照Cochrane协作网推荐的诊断试验的纳入标准筛选文献,提取纳入研究的特征信息.将入选研究和一项多中心的V/Q扫描的研究结果进行加权定量合并,计算汇总灵敏度和特异度及其95%可信区间,绘制汇总受试者工作特征曲线(SROC),计算曲线下面积.评价两种检查方法与肺动脉造影结果的一致性.结果 8篇评价CTPA的文献符合纳入标准.CTPA的汇总灵敏度和特异度分别为0.86和0.90,V/Q扫描的汇总灵敏度和特异度为0.82和0.60.二者的SROC曲线下面积(%)分别为94.43和81.90.CTPA与金标准肺动脉造影的诊断结果一致性较高.结论 CTPA诊断PE在准确性和确定性方面较V/Q扫描的价值高.鉴于CTPA的无创性及其与肺动脉造影结果的一致性,CTPA可作为肺动脉造影不能使用时的首选检查方法.     

急性肺栓塞CT肺动脉成像的研究进展

目前,CT肺动脉成像（CTPA）被认为是临床诊断急性肺栓塞（PE）的“金标准”。CTPA为诊断急性外周性PE提供了多方面的依据。但CTPA诊断急性外周性PE仍存在较大困难。目前CT辐射剂量及对比剂负荷为研究热点。本文对急性PE的CTPA诊断（尤其是外周性PE）、预后评估、CTPA技术进展等进行综述。     

Contemporary diagnostics of pulmonary arterial embolism

Nowadays, computed tomography along with pulmonary angiography (CTPA) is a recognized method of assumed pulmonary embolism (PE) diagnostics; however, even in experienced centers, CTPA sensitivity varies between 58 and 95%. Computed tomography with contrast venography and femoral scanning aimed at the diagnostics of profound venous thromboembolism, is a useful addition to CTPA. Besides these methods, some other well-known diagnostic techniques may be used in complex PE diagnostics: ventilation-perfusion pulmonary scanning, the evaluation of PE probability by clinical manifestations (P. Wells method), and digital subtraction angiography.     

Imaging diagnosis of acute pulmonary embolism

Pulmonary embolism represents a major public healthcare problem and it also imposes frequent clinical diagnostic issues. Despite the availability of the D-dimer tests, imaging remains the mainstay for its diagnosis. Computed tomography pulmonary angiography (CTPA) is now the most widely used diagnostic test and its utility has been well validated in a large number of trials. Nuclear medicine techniques, which are also well established, are now used significantly less frequently. Magnetic resonance pulmonary angiography is developing as an alternative to CTPA in patients who have contraindications to iodinated contrast media. Catheter pulmonary angiography remains the gold standard, although it is being used increasingly less frequently. In this article, we review the current knowledge on the imaging diagnosis of acute pulmonary embolism with special emphasis on the noninvasive techniques.     

Subsegmental pulmonary embolism diagnosed by computed tomography: incidence and clinical implications. A systematic review and meta‐analysis of the management outcome studies

Summary. Background: Multiple‐detectors computed tomographic pulmonary angiography (CTPA) has a higher sensitivity for pulmonary embolism (PE) within the subsegmental pulmonary arteries as compared with single‐detector CTPA. Multiple‐detectors CTPA might increase the rate of subsegmental PE diagnosis. The clinical significance of subsegmental PE is unknown. We sought to summarize the proportion of subsegmental PE diagnosed with single‐ and multiple‐detectors CTPA and assess the safety of diagnostic strategies based on single‐ or multiple‐detectors CTPA to exclude PE. Patients and methods: A systematic literature search strategy was conducted using MEDLINE, EMBASE and the Cochrane Register of Controlled Trials. We selected 22 articles (20 prospective cohort studies and two randomized controlled trials) that included patients with suspected PE who underwent a CTPA and reported the rate of subsegmental PE. Two reviewers independently extracted data onto standardized forms. Results: The rate of subsegmental PE diagnosis was 4.7% [95% confidence interval (CI): 2.5–7.6] and 9.4 (95% CI: 5.5–14.2) in patients that underwent a single‐ and multiple‐detectors CTPA, respectively. The 3‐month thromboembolic risks in patients with suspected PE and who were left untreated based on a diagnostic algorithm including a negative CTPA was 0.9% (95% CI: 0.4–1.4) and 1.1% (95% CI: 0.7–1.4) for single‐ and multiple‐detectors CTPA, respectively. Conclusion: Multiple‐detectors CTPA seems to increase the proportion of patients diagnosed with subsegmental PE without lowering the 3‐month risk of thromboembolism suggesting that subsegmental PE may not be clinically relevant.     

Imaging diagnosis of acute pulmonary embolism

Pulmonary embolism represents a major public healthcare problem and it also imposes frequent clinical diagnostic issues. Despite the availability of the D-dimer tests, imaging remains the mainstay for its diagnosis. Computed tomography pulmonary angiography (CTPA) is now the most widely used diagnostic test and its utility has been well validated in a large number of trials. Nuclear medicine techniques, which are also well established, are now used significantly less frequently. Magnetic resonance pulmonary angiography is developing as an alternative to CTPA in patients who have contraindications to iodinated contrast media. Catheter pulmonary angiography remains the gold standard, although it is being used increasingly less frequently. In this article, we review the current knowledge on the imaging diagnosis of acute pulmonary embolism with special emphasis on the noninvasive techniques.     

Computed tomography pulmonary angiography in the diagnosis of acute pulmonary embolism in the emergency department

This study was undertaken to evaluate the use of computed tomography pulmonary angiography (CTPA) in patients with pulmonary embolism (PE) who were followed in the emergency department (ED). The files and computer records of 850 patients older than 16 years of age who were seen in the Hacettepe University Hospital ED between April 10, 2001, and December 1, 2005, and who required CTPA for PE prediagnosis and/or another diagnosis, were studied retrospectively. PE was identified by CTPA in 9.4% of 416 women and in 5.8% of 434 men. A significant difference (P< .05) was noted in the women and men in whom PE was detected. The mean age of the patients was 58.13±17.88 y (range, 16–100 y). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for clinical susceptibility to PE among patients who underwent CTPA were assessed at 95.3%, 48.2%, 13%, and 99.2%, respectively. CTPA was done for different reasons: aortic aneurysm dissection (n=1), cough distinctive diagnosis (n=1), dyspnea distinctive diagnosis (n=6), chest pain distinctive diagnosis (n=3), PE prediagnosis (n=51), and other reasons (n=2). Also, sensitivity, specificity, PPV, and NPV were found to be 95.4%, 16.2%, 14.4%, and 96%, respectively, for D-dimer. CTPA, which is accessible on a 24-h basis in the ED, is a valuable tool for the diagnosis of PE.