电子束CT在诊断肺动脉栓塞中的应用

评价电子束ＣＴ（ＥＢＣＴ）在诊断肺动脉栓塞（ｐｕｌｍｏｎａｒｙｅｍｂｌｏｌｉｓｍＰＥ）中的作用。方法对２０例肺动脉栓塞患者进行回顾性分析,年龄２８－７８岁。应用ＩｍａｔｒｏｎＣ－１５０ＥＢＣＴ机,连续容积扫描（ＣＶＳ）或单层序列扫描（ＳＳＭ）层厚３ｍｍ或６ｍｍ     

肺动脉栓塞的螺旋CT血管造影的诊断研究(附七例报告)

目的评价螺旋ＣＴ血管造影（ＳＣＴＡ）诊断肺动脉栓塞（ＰＥ）的可信性。方法对７例临床怀疑ＰＥ的患者行螺旋ＣＴ血管造影,其中６例在溶栓治疗２０天后进行了复查。结果７例患者累及２０处肺动脉及其分支。栓子表现为肺动脉腔内柱状、丘状及不规则形充盈缺损。７例均有肺动脉高压,其中６例中心肺动脉扩张呈“残根征”改变。６例经溶栓治疗后,４例栓子完全消失,１例明显缩小,１例略有缩小。结论螺旋ＣＴ血管造影是诊断中心性肺动脉栓塞可靠而直观的检查方法,并可较准确地判断溶栓疗效。     

电子束CT在心血管系统疾病诊断中的应用

电子束与普通ＣＴ相比，其主要特点是电子枪取代了Ｘ线球管，从而使扫描速度大大加快，时间分辨率的极大提高，使之实现了对心血和病的检查，本文全面介绍了ＥＢＣＴ设备结构及其心血管系统疾病诊断中的最新进展，在此方面显示了较高的应用价值。     

电子束CT在急性肺动脉栓塞治疗中的应用价值

目的　探讨电子束CT(EBCT)在急性肺动脉栓塞 (PE)溶栓治疗中的应用价值。方法　 2 0 0 2 -0 5～ 2 0 0 3 -0 4经EBCT确诊的 9例急性PE ,8例行静脉溶栓及抗凝治疗。所有病例溶栓后 1～ 2周内行EBCT第 1次复查 ,5例更换药物治疗后EBCT第 2次复查。结果　 3例急性PE溶栓后第 1次EBCT复查示血栓完全或基本消失 ,5例效果不明显而更改治疗方案行第 2次静脉溶栓 ,EBCT 2次复查 2例血栓基本消失 ,另 3例则有明显好转。结论　EBCT不仅是诊断PE的重要检查方法 ,对溶栓后疗效的评价也有重要的指导意义 ,可作为治疗后随访的常规检查方     

螺旋CT在肺动脉栓塞诊治中的应用

目的 研究螺旋CT在肺动脉栓塞诊治中的临床应用。方法 本组46例，均经GE螺旋CT机胸部平扫及造影增强检查。其中26例又经下肢深静脉扫描。结果 46例中共275支血管发生栓塞，表现为不同程度的充盈缺损。对26例下肢肿胀者发现下肢深静脉血栓12例。46例均经溶栓治疗。溶栓治疗后19例复查CT，其中15例栓子完全消失，4例栓子不同程度缩小。结论 螺旋CT不仅是一种无创检出肺动脉栓塞的有效方法，尚可判断栓子来源指导溶栓方案，并可较准确判断溶栓疗效。     

低场MRI在慢性血栓栓塞性肺动脉高压诊断中的应用(附5例报告)

慢性血栓栓塞性肺动脉高压(chronic thromboembolic pulmonary hypertension.CTEPH)是指肺动脉及其主要分支由于血栓栓塞所导致的血流受阻,长期不能缓解或进行性加重,其形成与深静脉血栓形成(DVT)相关.在DVT基础上发生一次或反复多次肺动脉栓塞,长期发展形成肺动脉高压.随着检查技术的提高,肺栓塞(PE)已由过去的少见病成为常见病,且病残率及病死率均很高[1].MRI由于无创伤、敏感度高在CTEPH诊断中日趋成为首选检查方法.该法无须注射造影剂,便能清晰显示肺动脉及其主要分支的管腔,而此处血栓约占PE的27.8%[2].在临床诊断肺栓塞中有重要价值.低场MR由于软件功能的提高,图像质量已大有改善.本文收集了经MR检查、临床证实的5例肺动脉血栓病人作一回顾性分析,旨在提高低场MR在CTEPH检查中的应用价值.     

肺通气/灌注显像与电子束CT诊断肺栓塞的对比研究

肺栓塞的早期无创性诊断对尽早进行溶栓治疗、有效降低死亡率具有重要意义[1] 。本研究探讨了肺通气 /灌注(Ｖ/Ｑ)显像与电子束ＣＴ(ＥＢＣＴ)肺血管增强造影 2种诊断技术在肺栓塞定性和定位诊断中的作用 ,为正确评价和运用这 2种无创性影像技术提供依据。资料与方法5 0例患者 ,男 36例 ,女 14例 ,平均年龄 48岁。均行Ｖ/Ｑ显像和ＥＢＣＴ肺血管增强造影。分为 3组 ,Ａ组 2 7例 ,有典型的临床表现 ,经溶栓或抗凝治疗均明显有效 ;Ｂ组 13例 ,临床分别诊断为冠心病、肺气肿、先天性心脏病左向右分流和心律失常 ,均不支持肺栓塞诊断 ;Ｃ组 10例…     

甲状腺疾病的CT评价(附48例报告)

目的：探讨ＣＴ对甲状腺病变的诊断价值。材料与方法：分析经手术病理或临床生化证实的４８例甲状腺病变的ＣＴ表现其中甲头腺腺交谈２０例,腺癌１２例,Ｇｒａｖｅｓ病３例,桥本氏甲朱炎２例,多结节性甲状腺肿１１例。全部病例行ＣＴ扫,４５例增强。结果：全部病例均显示低密谋灶,最小病灶为６ｍｍ,ＣＴ术前定性诊断准确率为８３．３％。３例胸内甲状腺全部由ＣＴ首先检出,钙化以多结节性甲状腺肿多见,占５４．６％。１２例     

16层螺旋CT血管造影在肺动脉栓塞诊断中的应用

近年来，CT肺血管造影作为肺动脉栓塞诊断的首选方法而广泛采用。随着16层螺旋CT的普及应用，肺栓塞的检出率逐渐提高，肺栓塞已不再是以往被认为的少见病。本文对14例成功检出的肺栓塞的影像表现及16层螺旋CT肺血管造影诊断肺栓塞的应用价值进行探讨。     

螺旋CT肺动脉造影对于肺动脉栓塞的诊断价值(附8例报告)

目的评价螺旋CT肺动脉造影对于肺动脉栓塞的诊断及随访观察溶栓疗效的可靠性和准确性。方法经我院螺旋CT肺动脉造影诊断的8例肺动脉栓塞患者中有5例进行溶栓治疗。结果8例患者共有17处肺动脉及分支受累。动脉栓子呈偏于管腔一侧的突起状、不规则状和位于管腔中心的柱状及完全堵塞状态。5例溶栓治疗后有3例栓子完全消失，2例栓子明显缩小。结论螺旋CT肺动脉造影在诊断肺动脉栓塞和治疗随访观察疗效过程中都有着重要的价值，可望成为肺动脉栓塞诊断的首选方法。     

16层螺旋CT肺血管造影对亚段肺栓塞诊断的成像技术探讨

目的:研究16层螺旋CT肺血管造影在急性肺动脉栓塞(PE)诊断中的应用价值。着重探讨亚段水平周围型肺栓塞的适宜扫描参数及显示方法。方法:应用16层螺旋CT扫描机(GE ligtspeed 16)对临床拟诊肺栓塞的42例患者进行前瞻性研究。依据患者屏气时间长短,设定3组扫描参数。结果:CT诊断肺栓塞31例。中央型22例,周围型9例。3组扫描参数均可清晰显示亚段水平肺动脉栓子。高质量扫描模式肺动脉CTA成像质量最高,常规扫描模式次之,高速扫描模式再次之。结论:16层螺旋CT肺血管造影快速、无创、敏感性、特异性高。选择适宜扫描参数及显示方法,急性肺栓塞诊断可以达到亚段水平。2组常规扫描模式更为适宜PE患者。     

双能CT检测肺内孤立性结节钙化的价值

目的 探讨用双能ＣＴ检测肺内孤立性结节（ＳＰＮ）钙质存在的价值，建立一种判断ＳＰＮ良、恶性的新标准。方法 用双能（８０、１４０ｋＶｐ）ＣＴ扫描水模、体模、正常人体、ＳＰＮ，分析其ＣＴ值变化，计算ＳＰＮ钙盐含量，再用设定密度范围所占区域的面罩样后处理显示钙盐形态、分布，判断ＳＰＮ的良、恶性。结果 水模、体模、正常人体及ＳＰＮ中含有高原子序数物质时，低能较高能时ＣＴ值升高，且在ｄｅｎｓｉｔｙ ｍａｓｋ     

Reproducibility of multi-detector spiral computed tomography in detection of sub-segmental acute pulmonary embolism

The aim of this study was to evaluate the inter-observer and intra-observer agreement of the diagnosis of sub-segmental acute pulmonary embolism (PE) in an inpatient population explored by 16 slice multi-detector spiral computed tomography (MDCT). Four hundred consecutive inpatients were referred for MDCT for the clinical suspicion of acute PE. One hundred and seventy seven (44.2%) had a known cardio-respiratory disease at the time of examination. Inter-observer and intra-observer agreements for the diagnosis of acute PE and of sub-segmental acute PE were assessed blind and independently by three experienced readers and by kappa statistics. Seventy-five patients were diagnosed as having acute PE findings (19.5%), and clots were located exclusively within sub-segmental arteries in nine patients (12%). When clots were limited to sub-segmental or more distal branches of the pulmonary arteries, kappa values were found to be moderate (0.56) to very good (0.85) for the diagnosis of sub-segmental acute PE, whereas for the diagnosis of acute PE in the whole population, kappa values ranged from 0.84 to 0.97. Intra-observer agreement was found to be perfect (kappa=1). MDCT is a reproducible technique for the diagnosis of sub-segmental acute PE as well as for acute PE. In this inpatient population, sub-segmental acute PE was not a rare event.     

肺栓塞的螺旋CT诊断(附15例分析)

目的:探讨螺旋CT对肺栓塞的诊断价值。方法:回顾性分析15例肺栓塞患者CT平扫及增强扫描表现。结果:15例平扫显示片状实变影、磨玻璃影、楔型影、“马赛克”征等。增强扫描中央型肺栓塞12例,周围型肺栓塞3例;中央肺动脉扩张10例;右心室增大7例;支气管动脉显示15例,其中扩张6例;支气管静脉显示并扩张1例;根据肺动脉内栓子形态分4类。结论:CT对肺动脉栓塞具有较高的诊断价值。     

CT肺动脉成像在COPD中的应用

慢性阻塞性肺疾病(COPD)呈进行性恶化性发展,随病情进展将发生肺血管结构重塑、肺循环血流动力学改变、慢性肺源性心脏病,甚至导致死亡。CT肺动脉成像(CTPA)通过测量肺动脉及右心室各径线,可观察双肺及胸腔的情况,从而对COPD的病变过程进行动态监测,同时能够提供右心改变的信息,完成诊断并评估其严重程度。当CTPA联合超声及MRI检查时,可为临床选择治疗决策提供更多信息。就CTPA在COPD中的应用作一综述。     

Age-related incidence of pulmonary embolism and additional pathologic findings detected by computed tomography pulmonary angiography

Objective

To compare the incidence of pulmonary embolism (PE) and additional pathologic findings (APF) detected by computed tomography pulmonary angiography (CTPA) according to different age-groups.

Materials and methods

1353 consecutive CTPA cases for suspected PE were retrospectively reviewed. Patients were divided into seven age groups: ≤29, 30–39, 40–49, 50–59, 60–69, 70–79 and ≥80 years. Differences between the groups were tested using Fisher's exact or chi-square test. A p-value < 0.0024 indicated statistical significance when Bonferroni correction was used.

Results

Incidence rates of PE ranged from 11.4% to 25.4% in different age groups. The three main APF were pleural effusion, pneumonia and pulmonary nodules. No significant difference was found between the incidences of PE in different age groups. Furthermore, APF in different age groups revealed no significant differences (all p-values > 0.0024).

Conclusion

The incidences of PE and APF detected by CTPA reveal no significant differences between various age groups.     

Computed tomography pulmonary embolism index for the assessment of survival in patients with pulmonary embolism

This study was an analysis of the correlation between pulmonary embolism (PE) and patient survival. Among 694 consecutive patients referred to our institution with clinical suspicion of acute PE who underwent CT pulmonary angiography, 188 patients comprised the study group: 87 women (46.3%, median age: 60.7; age range: 19–88 years) and 101 men (53.7%, median age: 66.9; age range: 21–97 years). PE was assessed by two radiologist who were blinded to the results from the follow-up. A PE index was derived for each set of images on the basis of the embolus size and location. Results were analyzed using logistic regression, and correlation with risk factors and patient outcome (survival or death) was calculated. We observed no significant correlation between the CTPE index and patient outcome (p = 0.703). The test of logistic regression with the sum of heart and liver disease or presence of cancer was significantly (p< 0.05) correlated with PE and overall patient outcome. Interobserver agreement showed a significant correlation rate for the assessment of the PE index (0.993; p< 0.001). In our study the CT PE index did not translate into patient outcome. Prospective larger scale studies are needed to confirm the predictive value of the index and refine the index criteria. This work was supported by the European Commission Leonardo da Vinci grant.     

CTPA对肺动脉栓塞的诊断及临床应用价值

目的:探讨多层螺旋CTPA及后处理技术对肺动脉栓塞的诊断及临床应用价值。方法:回顾性分析40例经多层螺旋CTPA确诊为肺动脉栓塞的影像资料,并应用MPR、MIP、VR等后处理方法不同角度显示肺动脉及其栓子情况,观察肺动脉栓塞的征象,10例经临床治疗后行CTPA复查并与临床结果对照指导治疗。结果:40例肺动脉栓塞(PE)病例中,中央型PE32例,周围型PE8例。肺动脉内栓子表现为中心型、偏心型及闭塞型的充盈缺损。经治疗复查CTPA显示栓子变小或消失。结论:MSCTPA已成为诊断肺动脉栓塞的可靠方法,并为肺动脉栓塞的治疗提供必要的指导。