肺动脉栓塞的多层螺旋CT诊断与鉴别

目的研究肺动脉栓塞多层螺旋CT肺血管成像的影像表现,探讨与肺动脉栓塞表现相似疾病的鉴别,提高肺动脉栓塞诊断与鉴别诊断的水平。方法对21例肺动脉栓塞（1例为瘤栓）患者行多层螺旋CT肺动脉成像检查,图像采用10mm层厚,10mm层间距,和1．25层厚,0．625mm层间距进行重建,所获的数据传送至工作站运用MPR、MIP、VR技术后处理。结果20例中（不包括1例肺动脉肿瘤）,双侧肺动脉受累18例,单侧2例,病变累及131支肺动脉及分支。其中发生于左及右肺动脉远端18支,肺叶动脉38支、肺段动脉50支、肺段以下25支,CT显示的直接征象为肺动脉及分支血管内不同程度的充盈缺损,增强扫描不强化。充盈缺损依形态可分为4种：中心型（25支）、偏心型（61支）、附壁型（25支）、完全闭塞型（20支）。并存间接征象为主肺动脉及左右肺动脉增宽,局限性肺内灌注不均匀,肺梗死,胸腔积液及右房、右室增大。结论肺动脉栓塞在CT图像上形态多样,病变范围广泛,双侧发病多于单侧,主肺动脉受累少见。多层螺旋CT肺血管成像对本病的诊断有独特的优势,该方法能清晰显示肺动脉栓塞的直接征象和间接征象。为诊断及鉴别诊断提供可靠的影像学资料。     

多层螺旋CT肺血管造影在肺动脉栓塞中的诊断价值

目的 研究多层螺旋CT肺血管造影在肺动脉栓塞诊断中的诊断价值.方法 对18例经16层螺旋CT确诊的肺栓塞患者进行回顾性分析.结果 18例患者共累及224支肺动脉及其分支,其中肺动脉干1支,左、右肺动脉共9支,叶动脉45支,段动脉78支,亚段动脉及以下动脉分支91支.肺栓塞的CT表现:①直接征象:中心型充盈缺损、偏心型充盈缺损、附壁血栓、完全阻塞型充盈缺损.②间接征象:肺野透过度增高,肺纹理稀疏、细小,肺动脉高压,肺梗死,主、肺动脉增宽,右心室增大,心包积液、胸腔积液等.结论 多层螺旋CT肺血管造影是诊断肺动脉栓塞的一种快捷、无创、安全、可靠的影像诊断方法,对及时诊断和治疗肺动脉栓塞有重要的临床意义.     

16层螺旋CT肺动脉造影对肺栓塞诊断的应用价值

目的探讨16层螺旋CT在肺动脉栓塞中临床应用价值。方法选择肺动脉栓塞患者36例,所有患者均接受胸部CT及肺动脉造影检查,分析16排螺旋CT对肺动脉显影及肺栓塞显示情况,观察肺动脉栓子的类型、分布和数量。结果1.16排螺旋CT共显示肺动脉干、左/右肺动脉、肺叶、段、亚段及以下动脉1787支,肺动脉栓塞429支,栓塞率为24.01%,其中肺叶动脉比例最高,为38.79%,肺动脉干比例最低,为7.50%。在肺动脉栓塞栓子类型方面,Ⅱ型栓子数量最多,为202处,其次为Ⅳ型,共118处,Ⅲ型数量最少,为31处。其直接征象为充盈缺损,间接征象包括肺纹理稀疏、肺梗死、westemark征及肺动脉高压、胸腔积液、心包积液及胸膜增厚等。结论 16排螺旋CT能够清晰显示肺动脉栓塞的特点,在其诊断和鉴别诊断中具有较高的应用价值。     

超声心动图诊断急性肺动脉栓塞的价值

目的 :分析评价床旁超声心动图 (ECHO)在急性肺动脉栓塞 (APE)诊断中的实用价值。方法 :采用经胸ECHO对临床怀疑APE的 5 8例患者在 4～ 6h内行床旁ECHO检查。结果 :超声直接检出主肺动脉及左右肺动脉主干近端血栓者 4例 ,均被外科手术或肺动脉造影证实。本组具有典型右心负荷过重超声征象者 15例 (其中包括具有超声直接征象的 4例 ) ,核素肺灌注 通气扫描提示为双肺多发性大面积栓塞。仅右房、右室轻度增大或肺动脉轻度增宽者 19例 ,ECHO无改变者 2 4例 ,但核素肺灌注 通气扫描均提示为肺段或亚段栓塞。结论 :ECHO能够发现主肺动脉、左右肺动脉干内附壁血栓直接提示肺动脉栓塞 ,或根据右室负荷过重表现间接提示肺栓塞的可能 ,但对肺段或亚段栓塞者超声不能作出或排除诊断。     

16排螺旋CT血管成像在肺动脉栓塞诊断中的应用及其临床意义

目的 探讨16排螺旋CT血管成像在肺动脉栓塞诊断中的临床应用价值。方法 18例疑为肺栓塞的病人使用GELightSpeed16型多层螺旋CT设备行CT平扫和对比剂增强扫描检查,并通过最大密度投影(MIP)、多平面重组(MPR)及容积再现(VR)等影像后处理技术进行肺动脉三维成像。结果 在18例病人中肺动脉分支栓塞者6例,肺段及段以下动脉栓塞者12例,且可见11支亚段肺动脉栓塞,18例病例中单支肺动脉栓塞者4例,2支及多支栓塞者14例,多层螺旋CT血管成像(SCTA)的直接征像为中心型充盈缺损、偏心型充盈缺损和完全阻塞。结论 16排螺旋CT是诊断肺动脉栓塞的快速、有效、无创的诊断方法,可能成为诊断肺动脉栓塞的首选影像学检查手段。     

电子束CT在肺动脉血栓栓塞症诊断中的应用

目的评价电子束CT(EBCT)在肺动脉血栓栓塞症(PTE)诊断与鉴别诊断中的应用价值。方法回顾性分析1998年9月至2004年3月临床资料完整的114例肺血管疾病患者的临床资料,其中PTE76例,肺动脉炎29例,原发性肺动脉肿瘤5例,肺部或纵隔肿瘤累及肺动脉4例。本组患者采用ImatronC-150XP型EBCT机,连续容积扫描方式,扫描范围自胸廓入口至左侧肋膈角以下2cm,层厚1.5～3.0mm,层数为45～90层。单层扫描时间为100ms。造影剂(Omnipaque-300)总量约50～100ml,流速约3.0～4.0ml/s,延迟时间14～25s。以肺动脉管腔内充盈缺损为PTE的诊断标准,分析各级肺动脉受累情况。下肢深静脉检查采用血管超声。所有患者行X线胸片及超声心动图检查,43例行肺动脉造影检查,79例行核素肺通气灌注扫描。结果114例患者中男63例,女51例;年龄12～81岁,平均(47±13)岁;76例PTE患者CT诊断正确75例,准确率98.7%,其中58例有下肢深静脉血栓形成(DVT),占76.3%;无明确诱因8例,占10.6%。76例患者共2356支肺动脉,1668支肺动脉受累,占70.8%。中心肺动脉受累545支,占受累动脉的32.67%;外周肺段动脉受累1123支,占受累动脉的67.29%。中央型充盈缺损为急性血栓的特征性改变(包括轨道征、漂浮征等),血栓钙化为慢性血栓的特有征象。间接征象有马赛克征、右心房室增大、肺动脉增宽、肺梗死、心包或胸腔积液、肺不张或肺实变等。肺动脉炎(包括大动脉炎累及肺动脉)29例,16例经肺动脉造影证实,13例临床确诊;原发性肺动脉肿瘤5例,均经手术证实,CT误诊1例;肺部或纵隔肿瘤累及肺动脉4例,3例手术证实,1例经肺动脉造影证实。结论DVT-PTE是一种疾病的两个部分,PTE诊断的同时应兼顾下肢深静脉检查。对于PTE的诊断,EBCT是有效的无创检查方法,可初步诊断急性或慢性PTE,并能同时观察肺、纵隔及肺动脉周围组织及肺动脉、主动脉管壁情况,在肺动脉疾患的鉴别诊断中有重要地位。     

多层螺旋CT肺动脉造影对肺动脉栓塞的诊断价值（附15例报告）

目的 评价多层螺旋CT血管造影(MSCTA)在诊断肺动脉栓塞(PE)中的价值.方法 对15例经MSCT确诊肺动脉栓塞患者进行回顾性分析.结果 多发肺动脉栓塞10例,其中双侧多发7例,左侧多发1例,右侧多发2例;单发肺动脉栓塞5例,其中肺动脉干2例,叶动脉1例,段动脉2例.肺动脉栓塞的直接征象包括肺动脉主干或其分支的充盈缺损、肺动脉段面细小及管腔内不均匀密度减低;间接征象可以有肺内"马赛克征"、楔形影或索条状影、胸腔积液或胸膜肥厚.结论 多层螺旋CT肺动脉造影是诊断肺动脉栓塞的快速、有效、无创伤的诊断方法,尤其对亚段肺动脉栓塞是一种先进的方法,可以代替肺动脉造影,成为诊断肺动脉栓塞的首选方法.     

16层螺旋CT增强扫描诊断肺动脉栓塞征特点分析

目的探讨肺动脉栓塞征采用16层螺旋CT增强扫描诊断的临床特点。方法选择我院2009年1月—2011年1月收治的肺动脉栓塞征患者60例,采用16层螺旋CT进行增强扫描诊断,对临床资料进行回顾性分析。结果双肺叶动脉、肺动脉部分亚段及分支在螺旋CT增强扫描下显示率为100%,60例患者发现肺叶动脉栓塞89支,左、右肺动脉栓塞或肺动脉主干栓塞共84支,肺段动脉栓塞69支,亚段肺动脉栓塞52支。本组病例中双肺见斑片状实变影、渗出灶8例,伴胸腔少量积液38例,纤维条索影19例。结论螺旋CT检出阳性率达100%,优于国际报道的X线胸片检查,对确诊肺动脉栓塞有着积极的临床意义。     

螺旋CT肺动脉造影诊断肺动脉栓塞的价值

对16例肺动脉栓塞（PE）患者行螺旋CT肺动脉造影（SCTPA）,其中行单层SCTPA10例,显示155支肺动脉分支,栓塞78支;行多层SCTPA6例,显示164支肺动脉分支,栓塞62支。肺动脉栓塞的直接征象包括：中心型充盈缺损19支。偏心型充盈缺损51支,附壁血栓47支,完全阻塞型充盈缺损23支;间接征象为肺纹理稀疏10例,肺动脉高压4例,胸腔积液5例,肺梗死灶21个。证实SCTPA快速、安全、有效、无创,尤其是多层SCTPA可替代肺动脉造影成为诊断PE的首选方法。     

合并复杂病情的急性大面积肺栓塞的溶栓治疗

目的 :评价急性大面积肺栓塞合并复杂病情的溶栓疗效。方法 :对急性大面积肺栓塞合并复杂病情的 7例患者于溶栓前、后行心电图、动脉血气、超声心动图、肺灌注显像及电子束计算机断层摄影术 (EBCT)检查 ,评价溶栓疗效。结果 :7例大面积肺栓塞患者合并复杂病情 ,包括 :例 1合并妊娠、例 2和例 3反复发生肺栓塞、例 4并发休克、例 5并发矛盾性右肾动脉及肠系膜动脉栓塞、例 6为 82岁高龄及例 7肺灌注显像正常 ,而EBCT显示大块血栓堵塞主肺动脉内。 6例予重组组织型纤溶酶原激活剂 ,1例予尿激酶溶栓治疗。溶栓前平均动脉血氧分压及动脉二氧化碳分压分别为 62 9mmHg(1mmHg =0 133kPa)、31 6mmHg ,溶栓后分别上升至 82 0mmHg、36 6mmHg。超声心动图显示溶栓前右心室内径及估测肺动脉收缩压分别为 32 7mm、5 6 3mmHg ,溶栓后为 2 2 8mm、37 9mmHg。 7例肺灌注显像示溶栓前缺损肺段 7～ 15个不等 ,溶栓后 5例仅残余 3～ 5个肺段的缺损 ,肺灌注明显改善 ,2例正常。所有患者临床症状明显改善或完全消失 ,7例患者均好转出院。结论 :急性大面积肺栓塞合并复杂病情 ,如能得到正确诊断和及时有效的治疗 ,可挽救患者生命 ,改善预后。     

法乐四联症电子束计算机断层摄影术诊断的临床研究

目的明确电子束计算机断层摄影术(EBCT)对法乐四联症(简称法四)诊断的准确性,以及三维重建成像技术对心脏病理改变的直观反映.方法取连续20例年龄大于5岁,常规检查诊断的法四患者,对比其EBCT所见与术中探测的结果,并验证三维重建图像的准确性.结果EBCT临床诊断符合率为100%.对心脏的病理改变,包括主动脉骑跨程度、室间隔缺损(VSD)的位置,EBCT的诊断符合率分别为85%、95%.EBCT所测VSD、主肺动脉及右肺动脉、右心室流出道局限性狭窄处直径与术中实测结果比较经t检验P＞0.05,两者间无显著性差异.对合并畸形如冠状动脉异常的诊断,EBCT具有明显的优势.20例均获得满意的三维重建图像,此可详尽、准确地反映心血管的病理改变,并可多角度、任意层面地进行观察.结论EBCT用作法四的术前诊断,其结果精确、可靠.三维重建图像显示心血管病变可获近似病理解剖的效果.     

Contrast enhanced electron beam computed tomography to analyse the coronary arteries in patients after acute myocardial infarction

OBJECTIVE—To evaluate the accuracy of contrast enhanced electron beam computed tomography (EBCT) after acute myocardial infarction in determining patency of the infarct related artery and detecting high grade stenoses and occlusions in the coronary vessels.
DESIGN—Case study using blinded comparison with invasive coronary angiography.
PATIENTS—36 patients (mean age 53 years) 4-70 days after acute myocardial infarction.
INTERVENTIONS—The patients were studied by EBCT and invasive coronary angiography. For EBCT, 50 axial images of the heart (3 mm slice thickness) were acquired. They were triggered by the ECG during breath holding, after intravenous injection of contrast agent. The original images, surface reconstructions, and maximum intensity projections were evaluated for the presence of high grade stenoses and occlusions of the coronary arteries.
MAIN OUTCOME MEASURES—EBCT results were compared with invasive coronary angiography.
RESULTS—Of a total of 144 coronary arteries (left main, left anterior descending, left circumflex, and right coronary artery in 36 patients), 29 (20%) were unevaluable by EBCT. In the remaining arteries, 33 of 36 high grade lesions were correctly detected (92% sensitivity). Specificity was also 92% (73/79). Patency of the infarct related artery was correctly detected in 15 of 16 cases (94%). Five of the 14 occluded infarct related arteries (35%) were mistaken as stenotic but patent, and six could not be assessed.
CONCLUSIONS—EBCT is very accurate in detecting significant coronary artery lesions in patients after acute myocardial infarction, but differentiation between occluded and patent infarct related arteries is currently unreliable.


Keywords: electron beam CT; coronary angiography; myocardial infarction; computed tomography     

In vivo assessment of three dimensional coronary anatomy using electron beam computed tomography after intravenous contrast administration

Intravenous coronary angiography with electron beam computed tomography (EBCT) allows for the non-invasive visualisation of coronary arteries. With dedicated computer hardware and software, three dimensional renderings of the coronary arteries can be constructed, starting from the individual transaxial tomograms. This article describes image acquisition, postprocessing techniques, and the results of clinical studies. EBCT coronary angiography is a promising coronary artery imaging technique. Currently it is a reasonably robust technique for the visualisation and assessment of the left main and left anterior descending coronary artery. The right and circumflex coronary arteries can be visualised less consistently. Improvements in image acquisition and postprocessing techniques are expected to improve visualisation and diagnostic accuracy of the technique.


Keywords: electron beam computed tomography; coronary angiography; coronary anatomy; volume rendering     

N-Terminal Pro-B-Type Natriuretic Peptide Predicts the Burden of Pulmonary Embolism

BackgroundIn acute pulmonary embolism (PE), brain natriuretic peptides are markers of right ventricular dysfunction and they could point out the size of the occluded pulmonary vessel.MethodsN-terminal pro-B-type natriuretic peptide (BNP) was measured in 93 consecutive outpatients diagnosed with acute PE by means of helical computed tomography. Central PE was diagnosed when thrombotic material was seen in the main trunk or right or left main branches of the pulmonary artery, and peripheral PE was diagnosed when thrombi were seen exclusively in segmental or subsegmental arteries.ResultsCentral PE occurred in 51 (55%) patients and peripheral PE in 42 (45%). Plasma level of pro-BNP greater than 500 ng/L was independently associated with central PE. The area under the receiver operating characteristic curve was 0.753 (CI 95% 0.700-0.806), sensitivity 0.82 (CI 95% 0.69-0.91), specificity 0.67 (CI 95% 0.50-0.79), positive predictive value 0.75 (CI 95% 0.61-0.85), and negative predictive value 0.76 (CI 95% 0.58-0.87). Six (6%) patients died, 3 from PE, 2 from brain hemorrhage, and 1 from advanced gallbladder cancer. N-terminal pro-BNP level was greater than 500 ng/L in all patients who died. The area under receiver operating characteristic curve for death was 0.712 (CI 95% 0.635-0.789), sensitivity 0.10 (CI 95% 0.04-0.22), specificity 1 (CI 95% 0.88-1), positive predictive value 1 (CI 95% 0.51-1), and negative predictive value 0.42 (CI 95% 0.32-0.53).ConclusionsPreliminary data suggest that N-terminal pro-BNP levels higher than 500 ng/L could serve as indicator of the burden of PE and perhaps as a predictor of death.     

急性肺动脉血栓栓塞症核素肺灌注显像与电子束计算机断层摄影术的对比研究

目的通过对急性肺栓塞患者的核素肺灌注显像与电子束计算机断层摄影术(EBCT)的对比分析,初步探讨两者之间存在差异的原因和规律,以及肺动脉血管阻塞与血流灌注变化之间的对应关系。方法20例急性肺栓塞患者,24h内先后接受核素肺灌注显像和EBCT肺血管增强造影。逐个肺段对比EBCT所显示的肺动脉阻塞与肺灌注显像所显示的肺血流灌注的情况。结果多数(81.7%)肺动脉完全闭塞型病变对应相应肺段的灌注完全缺失,血流灌注分布与非完全闭塞型病变相比有显著性差异(P<0.01)。在非完全闭塞型病变中,多级肺动脉病变对应灌注完全缺失的比例较高(60.0%),多级肺动脉病变与单级肺动脉病变相比,血流灌注亦有明显的差异(P<0.05)。而不同类型的非完全闭塞型病变所对应的血流灌注没有明显差异(P>0.05)。结论不同形式的血管阻塞所造成的血流灌注变化的不同,是EBCT与肺灌注显像存在差别的主要原因之一,肺栓塞的血管阻塞和灌注受损是相互联系又有所不同的两个方面,肺灌注显像和EBCT结合应用能够使肺栓塞的诊断和疗效评价更加全面准确。     

Intravenous coronary angiography using electron beam computed tomography

Intravenous coronary angiography with electron beam computed tomography (EBCT) allows for the noninvasive visualisation of coronary arteries. With dedicated computer hardware and software, three-dimensional renderings of the coronary arteries, veins, and other cardiac structures can be constructed from the individual transaxial tomograms. Interest in this technique is growing, and recently a number of clinical studies have been published comparing EBCT coronary angiography with conventional cine-coronary angiography. In this article, image acquisition, postprocessing techniques, and the results of recently published clinical studies are discussed. EBCT coronary angiography is a promising imaging technique of coronary arteries. Currently, it is a reasonably robust technique for the visualization and assessment of the left main and left anterior descending coronary artery. However, at the moment a relatively high proportion of the right and circumflex coronary angiograms are noninterpretable. Improvements in image acquisition and postprocessing techniques are expected to improve visualization and diagnostic accuracy of the technique.     

Intravenous three-dimensional coronary angiography using contrast enhanced electron beam computed tomography

Coronary angiography remains the diagnostic standard for establishing the presence, site, and severity of coronary artery disease (CAD). Electron beam computed tomography (EBCT), with its 3-dimensional capabilities, is an emerging technology with the potential for obtaining essentially noninvasive coronary arteriograms. The purpose of this study was to (1) test the accuracy of intravenous coronary arteriography using the EBCT to conventional coronary arteriographic images; (2) establish the inter-reader variability of this procedure; (3) determine the limitations due to location within the coronary tree; and (4) identify factors that contributed to improved image quality of the 3-dimensional EBCT angiograms. Fifty-two patients underwent both EBCT angiography and coronary angiography within 2 weeks. The coronary angiogram and the EBCT 3-dimensional images were analyzed by 2 observers blinded to the results of the other techniques. EBCT correctly identified 43 of 55 significantly stenosed arteries (sensitivity 78%), and correctly identified 118 of 130 of the nonobstructed arteries, yielding a specificity of 91% (p <0.001, chi-square analysis). The overall accuracy for EBCT angiography was 87%. Significantly more left main and anterior descending coronary arteries were adequately visualized than the circumflex and right coronary vessels (p = 0.003). Overall, 23 of 208 (11%) major epicardial vessels were noninterpretable by the blinded EBCT readers, primarily due to motion artifacts caused by cardiac and respiratory motion and poor electrocardiographic gating. The inter-reader variability was similar to that of angiography, and its high accuracy makes this a clinically useful test. This study demonstrates, by using intravenous contrast enhancement, that EBCT can clearly depict the coronary artery anatomy and can permit identification of coronary artery stenosis.     

Giant coronary-to-bronchial arterial anastomosis complicated by myocardial infarction

A patient with giant extracardiac coronary anastomosis connecting the proximal right coronary artery and the right bronchial artery of the right middle and lower lobes had an inferior myocardial infarction. The pulmonary arteries were hypoplastic and those of the right middle and lower lobes were completely occluded. Left pulmonary arteries were also diffusely hypoplastic. Furthermore, this patient with rare coronary-to-bronchial arterial anastomosis and pulmonary arterial occlusion suffered from inferior myocardial infarction in the distal area of the anastomosis. This appears to be the first case of myocardial infarction reported in this type of anomaly.