螺旋CT肺动脉造影征象演变与治疗转归、肺动脉栓塞临床预测评分一致性分析

目的:探讨肺动脉栓塞(PE)螺旋CT肺动脉造影(CTPA)征象演变与肺动脉临床预测评分及治疗转归的一致性,以期三者之间的互相评估。方法:回顾性分析47例PE患者的CTA直接征象(充盈缺损、管腔突然狭窄、腔内网状改变、栓子钙化)和间接征象(主动脉和/或叶间肺动脉扩张、胸膜病变、肺梗死、"肺少血"征、右心功能不全、心包积液)用改良Geneva积分法对治疗前后的肺动脉栓塞患者进行评分,并与治疗前后的CTPA进行一致性对比分析。结果:PE患者经溶栓及抗凝治疗后,CTPA直接征象(除栓子钙化外)及间接征象检出率均不同程度降低,以Geneva积分形式进行危险分层,高度可能性10.64%(5/47)降低至4.26%(2/47),中度可能性59.57%(28/47)降低至34.04%(16/47),低度可能性29.79%(14/47)增加至40.43%(19/47)。结论:PE患者经溶栓及抗凝治疗后,Geneva积分与CTPA征象演变及治疗转归存在一致性,故在临床实践中,三者可以互相补充评估PE患者的临床情况、明确诊断及治疗效果。

Spiral CT pulmonary arteriography evolution and treatment outcome along with clinical prediction score of pulmonary embolism consistency analysis

Objective To evaluate the pulmonary artery embolism（PE） spiral CT pulmonary angiography（CTPA） image changes and pulmonary artery clinical prediction consistent outcome score and treatment,mutual evaluation between three persons.Methods A retrospective analysis of 47 patients with PE（CTA direct signs of filling defect,lumen stenosis,endovaseular net changes suddenly, embolus calcification） and indirect signs（aortic and/or dilatation of the pulmonary artery, interlobar pleural disease,pulmonary infarction,＂lung less blood＂ syndrome,right heart dysfunction,pericardial effusion） with the modified Geneva integral method of pulmonary embolism in patients before and after treatment were evaluated,and was compared with CTPA before and after treatment.Results In patients with PE,thrombolytic and anticoagulant therapy, CTPA direct signs（except the embolus calcification） and indirect signs detection rate were decreased in different degree,the risk stratification of Geneva integral form,a high probability of 10.64%（5/47） reduced to 4.26%（2/47） 59.57%（28/47）,moderate possibility is reduced to 34.04%（16/47）,1ow probability of 29.79%（14/47） increased to 40.43%（19/47）.Conclusion In patients with PE,thrombolytic and anticoagulant therapy, consistent outcome of Geneva integral and CTPA image changes and treatment,therefore,in clinical practice,the three can complement each other to assess PE in patients with clinical situation,diagnosis and treatment.