64层螺旋CT肺动脉造影在肺动脉栓塞诊断中的应用

目的 探讨64层螺旋CT肺动脉造影(CT pulmonary angiography,CTPA)对肺动脉栓塞(pulmonary embolism,PE)的诊断价值.方法 回顾分析24例肺动脉栓塞患者的64层螺旋CT增强图像,将原始图像复制到EBW4.0工作站,对肺动脉主干及分支进行多平面重建(MPR),最大密度投影(MIP)及容积重建(VR)分析.结果 24例患者中,共检出了76处肺动脉及其分支的栓子.其中,左、右肺动脉主干14处(右主干10处、左主干4处),肺叶动脉24处,肺段动脉26处,亚肺段动脉12处.CT表现为肺动脉主干或分支内混合性、附壁性、中心性充盈缺损,可分为完全性或部分性.结论 64层CTPA具有准确、高效、无创等优点,可直观、立体地观察到肺动脉血栓的大小、分布、范围及类型,是临床诊断及观察疗效的首选方法,有望成为肺动脉栓塞检查的“金标准”.

The application of 64-slice spiral CT pulmonary angiography in the diagnosis of pulmonary embolism

Objective To explore the value of puhnonary angiography with 64-slice spiral CT in the diagnosis of pulmonary embolism. Methods The images of 64-slice spiral CT pulmonary angiography of 24 patients with PE were retrospectively analyzed ,the original images were transfered to the EBW4.0 workstation, Multiplane reconstruction , maximal intensity and volume rending of the pulmonary artery main stem and its branches were performed to analyze. Results 76 embolisms of pulmonary arteries main stem and branches in 24 patients were detected , 14 embolisms were found in pulmonary arteries main stem （10 in right pulmonary arteries main stem, 4 in left main pulmonary arteries ）, 24 in lobar arteries, 26 in segmental arteries, and 12 in subsegmental arteries. The main CT manifestarion of pulmonary embolism showed as follows： mixed filling defect, mural filling defect, central filling defect in pulmonary arterial main stem or pulmonary arterial branches, which classified as complete defect and partial defect. Conclusion 64-slice spiral CT pulmonary angiography has the advantage of accurate, efficient and non-invasive for PE ,and it can observe the size, distribution , area and type of the embolism intuitively and solidly,and it is the first choice for the diagnosis and therapy effect of PE. 64-slice spiral CT pulmonary angiography expects to be the gold standard of the PE diagnosis.