16层螺旋CT血管造影在肺动脉栓塞中的应用价值

目的探讨16层螺旋CT血管造影(MSCTA)对肺动脉栓塞的诊断价值。方法33例患者行16层螺旋CT血管造影检查、薄层扫描及三维重建,三维重建方法包括容积再现(VR)、多平面投影(MPR)、最大密度投影(MIP)。结果33例均能显示肺栓塞的部位、范围、局部管腔狭窄程度,25例急性肺栓塞的直接征象为"截断征","双轨征";8例慢性肺动脉栓塞主要表现为肺动脉管腔内偏心性的和附壁性的充盈缺损。结论16层螺旋CT血管造影是诊断肺动脉栓塞及其溶栓疗效评价和随访最有效的无创性方法之一。     

超声心动图诊断急性肺栓塞的临床意义

目的探讨经胸彩色多普勒超声心动图诊断急性肺栓塞的价值。方法对63例临床诊断为急性肺栓塞的患者行经胸超声心动图检查,与CT各参数比较;并将肺动脉高压患者分为3组,进行组间分析。结果超声心动图发现右房内血栓1例,主肺动脉干或左右肺动脉血栓3例,右心腔增大38例,肺动脉增宽33例,右室壁运动异常19例,肺动脉高压45例,肺动脉血流流速曲线异常19例。CT发现右房内血栓及肺动脉内血栓7例,右心系统形态改变及肺动脉高压例数均低于超声心动图。3组肺动脉高压患者随肺动脉收缩压(SPAP)升高,右室舒张末期内径(RVDD)与主肺动脉内径明显增大(P<0.05)。结论超声心动图简便易行,对急性肺动脉栓塞的诊断有非常重要的价值。     

急性肺血栓栓塞的多排螺旋CT诊断

目的探讨多排螺旋CT对急性肺血栓栓塞(PE)的诊断价值.方法对临床怀疑急性PE的21例患者采用多排螺旋CT行薄层肺动脉造影(CTPA)及间接法深静脉造影(CTV).结果 CTPA检出12例急性PE,间接法CTV检出深静脉血栓8例.1 mm有效层厚图像对段、亚段肺动脉及其内血栓的显示高于3 mm有效层厚图像(P<0.05).结论多排螺旋CT能促进急性PE的诊断.     

经胸超声心动图检查在急性肺栓塞诊断与治疗中的价值

目的:探讨经胸超声心动图在急性肺栓塞诊断与治疗中的价值.方法:对经临床综合诊断(包括核素肺灌注扫描或CT血管造影)确诊为急性肺栓塞的患者46例进行经胸超声心动图检查.结果:超声心动图直接检出右室内血栓1例,主肺动脉及左、右肺动脉分支血栓5例.右心异常改变者26例(包括超声直接检出血栓的6例),其中右房室增大19例;右室收缩功能减退21例;室间隔左移、左室短轴切面室间隔向左室膨突呈"D"型改变1例;室间隔运动幅度减低13例;主肺动脉及右肺动脉增宽22例;三尖瓣中量以上返流23例;肺动脉收缩压增高23例,范围在33～81 mmHg(62.87±23.46 mmHg),治疗后肺动脉压明显下降,范围在21～52 mmHg (34.26±13.52 mmHg).结论:动态经胸超声检查是急诊诊断和治疗急性肺栓塞中重要无创影像诊断手段.     

多层螺旋CT及其图像后处理技术在急性肺栓塞诊断中的应用比较

目的探讨比较多层螺旋CT(MSCT)及其图像后处理技术在急性肺栓塞(PE)临床诊断中的临床应用效果。方法选取2016年7月至2018年7月于某院经临床确诊为肺栓塞的患者41例作为研究对象,所有受试者均采用多层螺旋CT检查,并采用容积再现(VR)、多平面重组(MPR)、最大密度投影(MIP)三种技术对多层螺旋CT检查的扫描图像进行后处理,对三种后处理技术在栓子的检出率以及肺动脉干、肺各级分支动脉的显示效果进行比较。结果 41例肺栓塞患者经多层螺旋CT检查,双肺均可见多发性的肺动脉栓塞,其中常规多层螺旋CT的检查图像发现受累的各级肺动脉分支共计612支,而经过图像后处理技术处理后的图像共发现受累的各级肺动脉分支共计665支,高于常规多层螺旋CT检查图像。三种图像后处理技术对于肺主动脉干、肺叶动脉、肺段动脉的显示数目、栓子数目及显示率相比,差异无统计学意义(P0.05),但是在亚段动脉及其以下级别的分支中,MPR后处理技术的分支显示数目、栓子数目及显示率要高于其他两种后处理技术,差异有统计学意义(P0.05)。结论运用多层螺旋CT进行急性肺栓塞临床诊断时,通过图像后处理技术能更好的显示肺动脉分支受累情况,提高栓子的检出率,其中MPR技术处理相较而言显示度要更高。     

肺栓塞的多层螺旋CT诊断和溶栓治疗效果评价

目的探讨多层螺旋CT在肺动脉栓塞诊断和溶栓治疗效果评估中的作用。方法对52例临床拟诊肺动脉栓塞的患者行16层螺旋CT肺动脉成像(CTPA)检查,并对其中20例经溶栓治疗2周后的患者进行同机同条件复查。结果52例中8例肺动脉成像未见异常,1例为动静脉瘘,5例诊断为肺动脉高压,38例诊断肺动脉栓塞。38例肺栓塞中共累及各级肺动脉236处,其中肺动脉干5支,左右肺动脉30支,叶动脉81支,肺段动脉103支,亚段动脉17支。20例经溶栓治疗后复查,病灶均不同程度缩小或消失。结论16层螺旋CT能及时发现和诊断肺栓塞,也可指导溶栓治疗及评价疗效。     

多层螺旋CT肺动脉造影在肺栓塞诊断中的应用

目的探讨多层螺旋CT肺动脉造影在肺栓塞诊断中的临床应用。方法19例肺动脉栓塞患者采用MSCT增强扫描,进行多平面重建(MPR)和最大密度投影(MIP)重建处理并计算CT肺动脉阻塞百分数。结果多层螺旋CT扫描肺动脉主干、左右肺动脉及叶、段、亚段动脉显示良好,显示受累肺动脉122支,其直接征象为肺动脉血管内充盈缺损,间接征象包括肺梗死、肺野少血征、胸腔积液等。CT肺动脉阻塞百分数分别从2.5%到75%不等。结论多层螺旋CT能清楚地显示肺栓塞的形态、发生部位及其他间接征象,为临床治疗提供帮助。     

多层螺旋CT对急性心肌梗死的评价

目的探讨多层螺旋CT冠状动脉成像评价急性心肌梗死的诊断价值。方法7例急性心肌梗死患者进行多层螺旋CT冠状动脉成像,测量心梗和非心梗区域的CT值。结果急性心肌梗死的主要CT表现为增强早期低密度区和冠状动脉狭窄/闭塞。心梗和非心梗区域的平均CT值分别为63±27HU和145±35HU。MSCT与临床诊断的符合率为85．7％(6／7)。结论MSCT能用于检测急性心肌梗死,同时能发现造成急性心肌梗死的冠状动脉狭窄或闭塞。     

螺旋CT血管造影对肺栓塞的临床诊断价值

目的前瞻性评价螺旋CT血管造影对临床疑诊为肺栓塞的诊断价值。方法对32例临床疑诊为肺栓塞的患者行螺旋CT血管造影(SCTA)及二维或三维重建,所有患者经多种影像检查方法和/或临床治疗随访证实。SCTA扫描参数取层厚3.0,螺距(pitch)1.5,用SmartPrep软件对比剂智能触发技术获得最佳延迟扫描时间。结果32例临床疑诊肺栓塞中,21例肺栓塞共累及肺动脉105支;SCTA确诊了19例,2例5个亚段肺动脉的栓子漏诊。在11例肺栓塞阴性中,SCTA对10例作出了正确诊断:2例肺癌,4例肺炎,1例夹层动脉瘤,3例未见明显异常;另外1例肺动脉肉瘤,SCTA误诊为肺栓塞。SCTA诊断肺栓塞的特异性90.9%,敏感性90.5%,准确性90.6,阳性预测值95.0%,阴性预测值83.3%。结论螺旋CT血管造影无创、快速、敏感性及特异性高,可作为诊断肺栓塞的首选检查方法。     

肺动脉栓塞的螺旋CT增强表现的探讨

目的 探讨肺栓塞螺旋CT增强扫描的影像表现，提高肺栓塞的诊断水平。方法 对14例肺栓塞患者行螺旋CT增强扫描，观察血栓累及部位及影像学表现。结果 14例患者共累及51处肺动脉及其分支，其中右肺动脉主干栓塞5例，左肺动脉弓3例，右上肺动脉6例，右中肺动脉4例，右下肺动脉13，左上肺动脉8例，左下肺动脉12例。肺栓塞的CT表现：①直接征象：肺动脉内充盈缺损，表现为中心型充盈缺损、锐角附壁型血栓、钝角附壁型血栓、完全阻塞型充盈缺损4种形式；②间接征象：肺动脉栓塞的间接征象有受累部分肺野透亮度增高、肺纹理细小稀疏、“马赛克”征、肺实变、主肺动脉增宽、右心室增大、胸腔积液、心包积液等。结论 螺旋CT增强扫描是诊断肺动脉栓塞的一种无创、快速的影像检查方法。     

多层螺旋CT动态三期扫描对肾囊肿CT值变化的观察研究

目的观察多层螺旋CT(MSCT)三期扫描下肾囊肿的CT值变化,分析"伪强化"现象及相关因素.方法对28例患者共48处肾囊肿病变进行MSCT三期扫描,测量囊肿CT值,计算强化差值并绘制散点分布图.结果平扫、皮质期、均衡期CT平均值分别为14.5 Hu、17.8 Hu、18.8 Hu,两增强组与平扫组对比均具有显著差异性(P＜0.05).皮质期(C-P)平均增强3.27±3.30)Hu;均衡期(N-P)(4.29±3.98)Hu.直径＞1 cm组平均强化(3.19±2.9)Hu,直径＜1 cm组(3.4±4.0)Hu,P=0.96.结论MSCT下肾囊肿会出现"伪强化"现象,一般＜10 Hu,"伪强化"强化程度与肾囊肿体积无显著的相关性,部分直径＜1.0 cm的病变"伪强化"可以大于10 Hu.     

Prevalence of pulmonary embolism in patients with acute exacerbations of COPD: A systematic review and meta-analysis

Study objectiveIdentification of pulmonary embolism (PE) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) carries significant therapeutic implications. We aimed to investigate the prevalence of PE in patients with AECOPD.MethodsWe searched MEDLINE, the Cochrane Central Register of Controlled Trials, and Embase. We registered the protocol at the PROSPERO (CRD42021230481). Two authors independently evaluated whether titles and abstracts met the eligibility criteria, which were as follows: (1), prospective study or cross-sectional study in case the protocol for workup of PE was specified in advance, (2) patients with AECOPD aged ≥ 18 years, and (3) investigated the prevalence of PE or venous thromboembolism (VTE). Two authors independently extracted the selected patient and study characteristics and outcomes. We presented the results of all analyses with the use of random-effects models. The primary outcome was the prevalence of PE.ResultsWe included 16 studies (N = 4093 patients) in this meta-analysis. The prevalence of PE in patients with AECOPD was 12% [95% confidence interval (CI), 9 to 16%]. Substantial heterogeneity was observed (I² = 94.8%). The pooled mortality was higher in patients with PE than those without (odds ratio 5.30, 95%CI: 2.48–11.30, p-value < 0.001).ConclusionIn this meta-analysis, the prevalence of PE in patients with AECOPD was 12% and the mortality of patients with PE was higher than those without. This suggests an acute necessity to develop validated diagnostic strategies for identifying PE in patients with AECOPD.     

Chronic CT features in PE patients with co-existing DVT

ObjectiveClinical features may be different in patients with PE without co-existing DVT compared to those with PE with co-existing DVT. This prospective study aims to investigate the different clinical features between patients with isolated pulmonary embolism (PE) and those with PE associated with deep venous thrombosis.MethodThis is a prospective study conducted in 107 consecutive patients diagnosed with acute PE in the emergency department or other departments of Kırıkkale University Hospital. The diagnosis of PE was confirmed by computed tomography pulmonary angiography (CTPA), which was ordered on the basis of symptoms and findings. Bilateral lower extremity compression ultrasound with standard 7.5 MHz linear array probe was applied to all patients. According to compression ultrasound results, the patients were divided into two classes as with and without deep venous thrombosis. Embolism in the main or lobar pulmonary arteries were classified as central, and those found only in segmental or subsegmental arteries were classified as peripheral. Laboratory parameters and Oxygen saturation were assessed on admission.Results67 of 107 (62.6%) patients with PE were isolated pulmonary embolism, and 40 (37.4%) were PE + DVT. Patients with PE with co-existing DVT have wider pulmonary artery, higher d-dimer and pro BNP level, and lower saturation than those with isolated pulmonary embolism. Central pulmonary embolism is more common in patients with deep vein thrombus than those without it. (87.5% (35/40) vs 32.8% (22/67),p = 0.001). 38.6% of central pulmonary embolism occur without deep vein thrombosis of the lower extremities.Patients with PE with co-existing DVT have 42.5% mosaic perfusion pattern,70% chronic infarct appearance such as linear band, pleural nodüle, %15.0 thickened, small arteries and, %12.5 shrunken complete artery occlusion, suggesting the chronic background.ConclusionPE patients with co-existing DVT are clinically more serious than those who do not have a DVT. An acute picture may be present in the chronic background in a significant proportion of patients with PE with co-existing DVT. In the presence of deep vein thrombosis, pulmonary embolism is usually central, but more than one-third of central pulmonary emboli occur without lower extremity deep vein thrombosis.     

原发性肺腺样囊性癌的CT表现

目的 观察原发性肺腺样囊性癌(ACC)的CT表现.方法 回顾分析26例经病理证实的原发性ACC患者的CT表现.结果 26例患者中中央型ACC 24例, 周围型2例;颈段气管病变5例,胸段气管病变11例,段及段以上大支气管病变8例,段以下小支气管病变2例;19例肿物向腔内外生长,7例肿物局限于腔内生长;病灶边界清楚,平扫密度较低、均匀,增强后无明显强化.结论 ACC CT常表现为低密度的中央型肿物,增强无明显强化.CT可显示病灶向腔外生长、管壁浸润性增厚等侵袭特性,对于ACC的诊断和治疗方案的制订有重要价值.     

胰腺癌瘤体强化程度与其恶性度的对照分析

目的探讨胰腺癌瘤体CT强化程度与其恶性度的关系。方法42例胰腺癌患者术前均行螺旋CT增强扫描,扫描延迟时间分别定为30s(胰腺实质期)、70s(门脉期)和180s(延迟期),以2.5～3.0ml/s速度团注对比剂100ml,观察胰腺癌胰实质期瘤体强化的程度和形式,结合胰腺癌病理组织学分级,对胰腺癌胰腺实质期的CT强化情况和病理级别作对照分析。结果胰腺高分化腺癌14例,平均胰腺-瘤体CT值差为(9.64±2.84)Hu,中分化腺癌16例,平均胰腺-瘤体CT值差(31.44±5.98)Hu,低分化腺癌12例,平均胰腺-瘤体CT值差(44.08±5.33)Hu,胰腺实质期病灶基本呈等密度强化13例,稍低密度强化15例,低密度强化伴小囊样改变9例,低密度强化伴大片坏死5例。胰腺癌实质期强化程度和形式与其病理分级有显著相关性,其秩相关检验结果为r=0.664(P<0.001)。结论胰腺癌实质期可以得到肿瘤的最大胰腺-瘤体密度差值,其瘤体强化程度和形式与其病理分级有显著相关性,即胰腺癌恶性度与其瘤体强化程度成反比。     

IVU后CT扫描对小儿先天输尿管畸形的诊断价值

目的探讨IVU/CT诊断小儿先天输尿管畸形的价值.方法 49例疑诊输尿管畸形患儿,行头低位腹部无加压静脉尿路造影,造影后20 min行CT扫描,观察IVU和IVU/CT显示肾脏、尿路及输尿管病变,并与手术结果对照.结果①16侧肾脏IVU不显影,IVU/CT示重度肾积水,其中UPJ 8侧,UVJ 4侧,发育不良重肾2侧,膀胱输尿管返流2侧;②IVU/CT 39侧积水肾实质密度(130.5±29.8) Hu,正常肾实质密度(82.4±19.0) Hu,二者存在显著差异 (P<0.05);③IVU、IVU/CT对39例UPJ、15例UVJ和15例重复肾输尿管畸形的诊断符合率分别为78.8%和 97.0% (P>0.05)、53.3%和100%(P<0.05)、40.0%和93.3% (P<0.001).结论 IVU/CT相当于肾脏CT增强延迟扫描,可不依赖肾功能丧失程度显示输尿管畸形;IVU/CT对输尿管末端梗阻和重复肾输尿管畸形的诊断具有重要价值.     

A novel ECG parameter for diagnosis of acute pulmonary embolism: RS time: RS time in acute pulmonary embolism

ObjectivesPulmonary embolism (PE) is one of the leading causes of cardiovascular mortality worldwide. Electrocardiography (ECG) may provide useful information for patients with acute PE. In this study, we aimed to investigate the diagnostic value of the QRS duration and RS time in inferolateral leads in patients admitted to the emergency department, and pre-diagnosed with acute PE.MethodsWe retrospectively enrolled 136 consecutive patients, admitted to the emergency department, pre-diagnosed with the clinical suspicion of acute PE, and underwent computerized tomographic pulmonary angiography (CTPA) to confirm the PE diagnosis. The study subjects were divided into two groups according to the presence or absence of PE, and the independent predictors of PE were investigated.ResultsSixty-eight patients (50%) had PE. Patients with PE had a longer RS time. Among the ECG parameters, only RS time was an independent predictor of PE (OR: 1.397, 95% CI: 1.171–1.667; p < 0.001). The ROC curve analyses revealed that the cut-off value of RS time for predicting acute PE was 64.20 ms with a sensitivity of 85.3% and a specificity of 79.4% (AUC: 0.846, 95%CI: 0.749–0.944; p < 0.001). In the correlation analyses; the RS time was correlated with RV end-diastolic diameter (r = 0.422; p < 0.001), RV/left ventricle (LV) ratio (r = 0.622; p < 0.001), and systolic pulmonary artery pressure (SPAP) (r = 0.508; p < 0.001).ConclusionAs a novel ECG parameter, RS time could be measured for each patient. A longer RS time can be a very useful index for diagnosing acute PE as well as for estimating the RV end-diastolic diameter and SPAP.     

Acute Pulmonary Embolism During Pregnancy and Puerperium: National Trends and In-Hospital Outcomes

ObjectiveTo investigate the trend and outcomes of acute pulmonary embolism (PE) during pregnancy and puerperium using a large national database.Patients and MethodsThe National Inpatient Sample was queried to identify pregnancy-related hospitalizations in the United States from January 1, 2007, through September 30, 2015. Temporal trends in the rates of acute PE and in-hospital mortality rates were extracted.ResultsAmong 37,524,314 hospitalizations, 6,333 patients (0.02%) had acute PE. The prevalence of comorbidities and risk factors such as hypertension, obesity, and smoking increased, but rates of acute PE did not change significantly (18.01 in 2007 vs 19.36 in 2015, per 100,000 hospitalizations, P_trends=.21). Advanced therapies were used in a small number of women (systemic thrombolysis: 2.4%, surgical pulmonary embolectomy: 0.5%, and inferior vena cava filter in 8.3%). Rates of in-hospital mortality were almost 200-fold higher among those who had acute PE (29.3 vs 0.13, per 1000 pregnancy-related, P<.001). The rate of in-hospital mortality did not change among women with acute PE (2.6% in 2007 vs 2.5% in 2015, P_trends=.74).ConclusionIn this contemporary analysis of pregnancy-related hospitalizations, acute PE was uncommon, but rates have not decreased over the past decade. Acute PE during pregnancy and puerperium was associated with high maternal mortality, and the rates of in-hospital mortality have not improved. Future studies to improve prevention and management of acute PE during pregnancy and puerperium are warranted.     

Survival of patients with acute pulmonary embolism treated with venoarterial extracorporeal membrane oxygenation: A systematic review and meta-analysis

BackgroundTo examine whether venoarterial extracorporeal membrane oxygenation (VA-ECMO) improves survival of patients with acute pulmonary embolism (PE).MethodsFollowing the PRISMA guidelines, a systematic search was conducted up to August 2019 of the databases: PubMed/MEDLINE, EMBASE and Cochrane. All studies reporting the survival of adult patients with acute PE treated with VA-ECMO and including four patients or more were included. Exclusion criteria were: correspondences, reviews and studies in absence of a full text, written in other languages than English or Dutch, or dating before 1980. Short-term (hospital or 30-day) survival data were pooled and presented with relative risks (RR) and 95% confidence intervals (95% CI). Also, the following pre-defined factors were evaluated for their association with survival in VA-ECMO treated patients: age > 60 years, male sex, pre-ECMO cardiac arrest, surgical embolectomy, catheter directed therapy, systemic thrombolysis, and VA-ECMO as single therapy.ResultsA total of 29 observational studies were included (N = 1947 patients: VA-ECMO N = 1138 and control N = 809). There was no difference in short-term survival between VA-ECMO treated patients and control patients (RR 0.91, 95% CI 0.71–1.16). In acute PE patients undergoing VA-ECMO, age > 60 years was associated with lower survival (RR 0.72, 95% CI 0.52–0.99), surgical embolectomy was associated with higher survival (RR 1.96, 95% CI 1.39–2.76) and pre-ECMO cardiac arrest showed a trend toward lower survival (RR 0.88, 95% CI 0.77–1.01). The other evaluated factors were not associated with a difference in survival.ConclusionsAt present, there is insufficient evidence that VA-ECMO treatment improves short-term survival of acute PE patients. Low quality evidence suggest that VA-ECMO patients aged ≤60 years or who received SE have higher survival rates. Considering the limited evidence derived from the present data, this study emphasizes the need for prospective studies.Protocol registrationPROSPERO CRD42019120370.     

阻塞性通气障碍的CT肺功能成像参数

目的建立诊断肺气肿及阻塞性通气障碍的CT肺功能参数阈值.方法对照组20例,阻塞性通气障碍组37例(包括肺气肿23例、哮喘6例、不明原因8例).肺功能检查和定量CT检查均在1周内完成.利用CT肺功能定量分析软件分析图像数据并得出相应的肺功能参数值,包括肺平均CT密度值、像素指数(PI-700～800,PI-800～-900,PI-910,PI-950),比较各组参数值的差异.结果阻塞性通气障碍组最大吸气末CT值为(-834.68±29.54)Hu,最大呼气末CT值为(-770.48±55.07)Hu,与正常组均存在差异.吸气末及呼气末PI-910in、PI-910ex与PFT各参数(FEV1,FEV1/FVC,DLco%)的相关性分别较其他像素指数要好.PI-910in＞15%考虑患有阻塞性通气障碍,PI-950in、PI-910ex的分布代表阻塞性通气功能障碍的范围,PI-950ex代表肺气肿的分布范围.结论建立CT肺功能成像参数阈值可为临床诊断相关疾病提供客观依据.