64层螺旋CT肺血管造影在肺栓塞诊疗中的应用价值

目的 探讨64层螺旋CT在肺栓塞诊断及治疗中的指导作用。方法 63例患者均行64层螺旋CT肺血管造影(CTPA),并进行多种形式的图像重建结合轴位图像分析。结果 64层螺旋CTPA对63例患者肺动脉各级管腔内的栓子均明确显示,共累及肺动脉303支;图像分析结果伞部显示肺栓塞的直接征象为:主肺动脉和(或)左右肺叶、段、亚段血管腔内充盈缺损和血管阻塞;部分显示肺栓塞的间接征象为:马赛克征、右心房及右心室肥厚及扩张、肺动脉扩张、胸腔积液、肺不张及实变(肺梗死)等。62例患者经溶栓治疗后复查CTPA,其中,栓子完全消失者47例,栓子明显缩小者11例,溶栓治疗效果差者3例,考虑为慢性肺栓塞。结论 64层螺旋CTPA是临床最有效的诊断肺栓塞及溶栓后疗效评价的无创性方法之一。

Assessment of 64-slice spiral CT pulmonary angiography in diagnosing of pulmonary embolism

Objective To assess the clinical usefulness of 64-slice spiral CT pulmonary angiography (CTPA) in diagnosing of pulmonary embolism. Methods Sixty-three patients with clinically known pulmonary embolism underwent 64-slice spiral CTPA. The source images of all the patients were reconstructed with the 3D techniques including multiplanar reconstruction, maximum intensity projection and volume rendering, CT axial images features were analyzed. Results Three hundreds and three embolus were found in 63 cases patients.The direct diagnostic findings of pulmonary embolism including: 64-s1ice spiral CTPA clearly showed the sites,extensions and stenosed lumens of pulmonary embolism in all patients. Pulmonary embolism lesions appeared as intra-luminal irregular-plaque shape and adhered-mural filling defects. The indirect diagnostic findings of pulmonary embolism including: dmosaic signs, dilation of the right ventricle and atrium, pulmonary artery enlargement, pleural effusion, pulmonary atelectasis and pulmonary consolidation(pulmonary infarction). There are 47 patients whose thrombosis disappeared after therapy in 62 patients, 11 became smaller and 3 were chronic pulmonary embolism. Conclusion 64-slice spiral CTPA is one of the most effective and non-invasive imaging modalities in the diagnosis before and after therapy of pulmonary embolism.