MSCT肺血管造影在肺动脉栓塞诊断中的应用

目的:探讨MSCT肺血管造影在肺动脉栓塞诊断中的应用.方法:10例肺动脉栓塞患者采用MSCT增强扫描,并进行多平面重建结果:应用16排螺旋CT扫描主肺动脉、叶肺动脉、段、亚段动脉显示良好,显示受累肺动脉72支,其直接征象为肺动脉充盈缺损,间接征象包括肺梗死、肺少血征、胸腔积液.结论:16层螺旋CT能清楚地显示肺栓塞的直接征象及间接征象,及时发现和诊断肺栓塞.     

多层螺旋CT肺血管造影对肺动脉栓塞的诊断价值

目的 探讨MSCT肺血管造影对肺栓塞的诊断价值.方法 Ⅰ组25例采用2.5 mm准直,3.2 mm层厚扫描.Ⅱ组10例采用1 mm准直,1.3 mm层厚扫描.2组中5例患者在MSCTPA后行下肢深静脉扫描.结果 2组对主肺动脉、叶肺动脉显示无差异,对段、亚段及5级分支显示,1 mm准直优于2.5 mm准直.MSCTPA显示受累肺动脉486支,肺动脉充盈缺损包括中心型(276支),锐角附壁型(87支),钝角附壁型(12支),完全附壁型(111支).急性肺栓塞31例,慢性肺栓塞4例.间接征象包括肺梗死、肺少血征、马赛克征、胸腔积液、主肺动脉和/或叶肺动脉扩张、右心室增大、室间隔移位等.CTV显示双侧股静脉栓塞3例,单侧股静脉及股深静脉栓塞2例.结论 多层螺旋CT肺血管造影能清楚显示肺栓塞的直接征象及间接征象,1 mm准直薄层扫描能发现更多外围肺动脉栓塞,MSCTPA与CTV联合成像有助于肺栓塞的确诊.     

多层螺旋CT肺动脉造影在肺栓塞诊断中的应用价值

肺栓塞是一种有潜在生命危险的疾病.多层螺旋CT肺动脉造影能清楚显示肺栓塞的形态、发生部位及其他间接征象,有助于诊断或排除肺栓塞.MSCTPA具有快速、无创、敏感性和特异性高、时间和空间分辨率高等优点,目前已作为临床诊断肺栓塞的首选影像学检查方法.     

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.     

螺旋CT肺动脉造影诊断肺栓塞的临床应用研究

目的评价螺旋CT肺动脉造影(sp iral CT pu lmonary angiography,SCTPA)诊断肺栓塞的临床价值及其限度。方法52例肺栓塞均行SCTPA检查。SCTPA扫描时间为0.8 s,扫描层厚3 mm,螺距1.5~2.0,重建层厚1 mm,重建方法包括M IP、MPR和SSD。结果统计52例肺栓塞的2898支血管,其中927支血管SCTPA检出肺栓塞直接征象,约占32.0%;1302支段以上肺动脉中,728支显示肺栓塞的直接征象;1896支亚段肺动脉中,199支显示直接征象。平扫显示间接征象共113例次。结论SCTPA是一种高效、无创性的肺栓塞检查方法,对段以上肺栓塞不仅可做准确的定性诊断,而且可定量分析,但对亚段以下肺栓塞的诊断受限。     

肺动脉栓塞的CT血管造影检查

目的研究CT肺动脉血管造影联合下肢深静脉血管造影在肺栓塞的诊断中的作用及多层螺旋CT的优势。方法采用单层螺旋CT或16层螺旋CT对临床拟诊肺栓塞的所有患者行肺动脉血管造影(CTPA)及下肢静脉血管造影,统计栓塞的数目及类型。结果44例肺栓塞中,肺栓塞合并下肢静脉栓塞的34例,单纯肺栓塞的10例。单层螺旋CT及16层螺旋CT检查的病人总的栓塞显示率分别为12.1%及19.0%,差异有统计学意义(P=0.004);肺段及肺段以上肺动脉栓塞的显示率分别为25.3%及29.7%,差异无统计学意义(P=0.104);亚段及亚段以下显示率分别为1.1%及10.2%,差异有统计学意义(P=0.000)。结论CT肺动脉血管造影联合下肢血管造影是肺栓塞的无创、快速、敏感性和特异性均较高的诊断方法。16层螺旋CT在检查肺栓塞方面优于单层螺旋CT。     

肺栓塞的磁共振成像技术应用研究

目的探讨MR I透视触发造影剂团跟踪和动态增强磁共振血管成像(DCE-MRA)扫描技术在肺灌注和肺动脉血管造影中的应用价值。方法8例疑有肺栓塞的患者,应用MR I透视触发造影剂团跟踪和DCE-MRA扫描技术,行肺动脉血管造影和肺灌注成像。结果8例均成功进行肺动脉血管造影和肺灌注扫描,其中2例正常,6例发现肺动脉血栓形成,并有明确动态显示的局部肺叶灌注异常。结论MR I透视触发造影剂团跟踪和DCE-MRA扫描技术的应用,可1次注射造影剂既发现了肺动脉内血栓,又可显示肺内灌注缺损,是较好的肺栓塞诊断方法。     

螺旋CT肺血管造影对老年人肺栓塞的临床诊断价值

目的 评价螺旋CT肺血管造影(CTPA)对老年人肺栓塞的诊断价值.方法 对64例临床疑诊为肺栓塞的老年患者行螺旋CT 血管造影及二维或三维重建.CTPA 扫描参数取层厚2.0 mm,螺距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 64例临床疑诊肺栓塞中,40例确诊为肺栓塞,共累及肺动脉850支.CTPA确诊36例,4例共5个亚段肺动脉的栓子漏诊.CTPA 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血管造影在老年人肺栓塞的诊断中非常重要.     

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。     

3D-CE-MRPA诊断周围性肺栓塞的研究

目的：探讨三维增强磁共振肺血管造影(3D-CE—MRPA)对周围性肺栓塞的诊断价值。方法：8只犬于DSA下经导管将直径2—4mm、长1cm左右的明胶海绵条注入单侧肺动脉后复制为周围性肺栓塞动物模型，然后进行3D-CE—MRPA检查，观察栓塞肺动脉的CEMRPA显示情况及表现形式，分析CEMRPA诊断肺栓塞的敏感性。结果：在DSA显示的26支肺段及其以下水平栓塞肺动脉中，CEMRPA显示了21支，敏感性为80．77％，特异性为100％。栓塞肺动脉主要表现为完全或不完全截断，远侧肺野可见低灌注区存在。多平面重建协助诊断了4支原始图像上显示不清的栓塞肺动脉。结论：3D-CE—MRPA对周围性肺栓塞有较高的诊断敏感性，是诊断周围性肺栓塞的理想方法。多平面重建有助于诊断原始图像上显示不清的栓塞肺动脉。     

Pulmonary varix clearly demonstrated by 3D-CT before pulmonary angiography

Pulmonary varix is a rare and usually asymptomatic localized dilation of a pulmonary vein. This disease should be distinguished from other pulmonary and mediastinal diseases, particularly pulmonary arteriovenous malformations. Herein, we encountered a case of pulmonary varix clearly demonstrated by 3-dimensional reconstructed computed tomography (3D-CT) which proved useful in its diagnosis. The 3D-CT enabled easy understanding of the vascular connections and confirmation of the absence of an inflow pulmonary artery. We also performed angiography which showed findings consistent with those obtained by the 3D-CT, thus confirming the diagnosis of pulmonary varix. After the diagnosis, the patient was followed up for several years without any treatment and she remained asymptomatic. On follow-up CT, the lesion remained unchanged.     

Unresolved major pulmonary embolism: Importance of follow-up lung scan in diagnosis

Unresolved major pulmonary embolism (UMPE) is an uncommon condition which causes pulmonary hypertension, cor pulmonale and death. An accurate and prompt diagnosis of UMPE is very important in the management of such patients with pulmonary embolectomy. Follow-up lung scans can lead to earlier diagnosis of UMPE, especially in patients who have a history of acute pulmonary embolism and present with pulmonary hypertension, respiratory insufficiency and cor pulmonale. We report a case of UMPE strongly suggested by follow-up lung scans and subsequently confirmed by pulmonary angiography and postmortem examination.     

经导管血管内栓塞术治疗肺动静脉畸形

目的 评价经皮穿刺经导管栓塞术治疗肺动静脉畸形(PAVMs)的安全性和疗效。资料与方法 对10例PAVMs患者进行了经导管栓塞治疗,男4例,女6例,平均年龄12岁(6个月～28岁),均为先天性。临床表现有紫绀和杵状指／趾7例,劳力性呼吸困难6例,胸部血管杂音4例,咯血2例和心功能不全2例。栓塞时用微型钢丝圈2例,普通钢丝圈8例。结果 PAVMs病灶为多发性7例,单发性3例。10例共做栓塞治疗12次,技术成功率为100％,治疗结束时复查肺动脉造影显示单发病灶完全消失,多发病灶者主要异常血管不再显影。术后血氧饱和度从平均78％增至96％。2例术前存在心功能不全,术后症状消失;胸部血管杂音消失。术后出现轻微胸痛5例,少量胸腔积液3例;1例术后2个月死于栓塞肺叶肺梗死继发化脓性感染。9例随访18个月～9年,一般情况良好,日常生活正常,无神经系统症状和体征,除2例弥漫型动静脉畸形血氧饱和度持续在85％～90％外,其余缺氧症状未再复发。结论 经导管血管内栓塞术是治疗PAVMs的安全、有效方法。     

正常成人主肺动脉的HRCT测量及其意义

目的：探讨通过正常成人主肺动脉的ＨＲＣＴ测量诊断肺动脉高压与否的可能性。方法：连续测量２００例正常成人主肺动脉直径（外径）并计算其与同一层面降主动脉直径（外径）的比值,另外采用相同方法测量１１例６０～７８岁一组已经ＣＴ与彩色Ｄｏｐｐｌｅｒ证实的ＣＯＰＤ患者主肺动脉直径及与降主动脉直径的比值并与正常组比较。结果：正常成人不同年龄,不同性别主肺动脉直径不同并有随年龄增长而增大的趋势（Ｐ＜０．０５）,但其比值与年龄有关（Ｐ＜０．０５）与性别无关（Ｐ＞０．０５）,其比值与ＣＯＰＤ患者的比值比较存在显著差异（Ｐ＜０．０１）。结论：正常成人不同年龄组主肺动脉与降主动脉的比值可作为判断肺动脉高压与否的简单、敏感的指标     

孤立性周围型原发肺癌的CT诊断(附58例肺癌及20例肺良性肿块的分析)

本文分析了58例孤立性周围型原发肺癌(简称肺癌)和20例肺良性肿块的CT征象,观察了5例肺癌、2例错构瘤、1例结核球的肺叶切除标本。结果为:①等于或大于5.0cm的肺部肿块绝大多数为肺癌(93.9％);②肺癌钙化并不少见(6.9％),中心性弥漫性钙化并非是肺部肿块为良性的可靠指征;③假性空洞是诊断肺癌的一个指征,其病理基础为肿块内残存的小支气管;④引流线仅见于肺癌,其存在表示肺门淋巴结已受累;⑤薄层CT更清晰地显示肿块的边缘特征、内部结构和肿块与周围组织的关系。     

三种心血管造影组合对肺动脉闭锁肺动脉发育情况的评价分析

目的评价分析三种心血管造影组合显示肺动脉闭锁合并室间隔缺损的肺动脉发育情况。资料与方法回顾性分析22例肺动脉闭锁合并室间隔缺损患者的临床资料,包括X线平片、心电图、超声心动图和心血管造影。重点分析三种造影组合对显示肺动脉发育情况的优缺点。结果（1）右心室造影＋楔入肺静脉造影共3例,均显示左右肺动脉融合,一侧肺动脉发育细小。（2）右心室造影＋弓降部主动脉和／或升主动脉造影共15例,其中11例主要由未闭动脉导管供血,均见左右肺动脉融合,融合部狭窄3例,一侧或双侧肺动脉发育不良或变细8例,2例可见主肺动脉及盲端;另4例左右不融合。（3）右心室造影＋弓降部主动脉或升主动脉造影＋体肺侧支血管造影共4例,其中1例由细小动脉导管供血,左右肺动脉融合并发育较好;3例均由小体肺侧支和网状细小血管供血,肺动脉发育细小。结论三种心血管造影组合均能有效显示肺动脉发育情况,主动脉造影能全面了解体肺侧支血管分布,选择性侧支血管造影是术前栓塞所必要的;楔入肺静脉造影可极好地显示纵隔内肺动脉的情况。     

功能性肺叶切除动物模型肺小动脉变化的观察

目的 探讨应用平阳霉素-碘化油乳剂（PLE）实现功能性肺叶切除（FPLT） 的可行性及肺小动脉的病理变化,评价其对肺循环的影响. 材料与方法健康犬16只,随机分成两组,A组12只,B组4只.A组行靶肺支气管肺泡灌注PLE并用支气管封堵器堵塞靶肺支气管,B组为对照组.A组分别于术后28天、56天各处死6只取肺组织,B组各处死2只,测定肺纤维化的程度,运用图像分析仪测量肺小动脉中膜厚度占血管外径比值（mMTPA）和相对中膜面积（WA/TA）. 结果 FPLT术后A组动物组织病理学显示靶肺呈纤维化改变,肺小动脉管壁增厚,管腔部分闭塞;非靶肺未见明显纤维化,未出现血管重构现象. 结论 向靶肺支气管肺泡灌注PLE并用支气管封堵器堵塞靶支气管可达到功能性肺叶切除的目的 ,该方法安全、简便,术后对肺循环无明显不良影响.     

Coil embolization of pulmonary arteriovenous malformations

Pulmonary arteriovenous malformations (PAVMs) are uncommon lesions that can be treated by surgery or interventional radiology. Forty-four PAVMs in 11 patients were occluded by transcatheter coil embolization with only one symptomatic complication, deep venous thrombosis, attributable to the procedure. There was a significant improvement in symptoms and a reduction in pulmonary AV shunting in the 9 patients in whom embolization of all visible discrete lesions was successfully completed. Coil embolization is an effective alternative to other methods of treating PAVMs.     

Clinically suspected pulmonary embolism: is it safe to withhold anticoagulation after a negative spiral CT?

The goal of this study was 3-month clinical outcome in non-anticoagulated patients with clinically suspected acute pulmonary embolism (PE) following a negative spiral CT. During a 6-month period 305 patients underwent spiral CT, of whom only 8 also had a lung scintigraphy. In patients with a final CT report read as not positive for acute PE, all hospital records and answers to a patient questionnaire were analyzed for episodes of venous thrombembolism (VTE). Acute PE was diagnosed at spiral CT in 61 patients (20 %). Twenty-six of the remaining 244 patients were excluded from further analysis because of (a) long-term anticoagulation due to symptomatic acute deep venous thrombosis (n = 5), clinically diagnosed acute PE (n = 2), chronic recurrent VTE (n = 4), and cardiac disorders (n = 5); and (b) a normal perfusion scintigram (n = 4) or a negative pulmonary arteriogram (n = 6). Three patients were lost to follow-up. Among the remaining 215 patients only 10 had undergone a negative lower extremity venous study. Sixteen patients (7 %) died during the follow-up period, 6 of whom underwent autopsy. Venous thrombembolism was diagnosed in three of the 215 patients (1.4 %, 95 % confidence limits: 0.5–4.0 %), one causing the patient's death. Two patients had advanced thoracic malignancies and the third severe chronic obstructive pulmonary disease (84 years old). A negative spiral CT may be able to exclude clinically significant acute PE with the same accuracy as a normal lung scintigraphy or a negative pulmonary arteriography. Received: 8 February 2000 Revised: 18 May 2000 Accepted: 22 May 2000     

Comparison of perfusion lung scanning and angiography in the estimation of vascular obstruction in acute pulmonary embolism

To determine the relationships between perfusion scan defect and angiographic severity (Miller index) in acute pulmonary embolism, we analysed examinations obtained before and after thrombolytic therapy in 34 consecutive patients free from underlying cardiopulmonary disease. The overall agreement between the two techniques was excellent (r=0.82; mean absolute difference=2.8%), although when embolic involvement was extensive (greater than 50% angiographic obstruction), the perfusion scan moderately underestimated (4%) the defect seen angiographically. These findings suggest that the pulmonary lung scan is a reliable method of assessing the initial pulmonary vascular obstruction as well as of quantifying any changes induced by or associated with the treatment.French exchange travelling fellow