经胸超声心动图在肺动脉栓塞诊断中的应用价值

目的 探讨经胸超声心动图(TTE)对肺动脉栓塞(PE)的诊断价值.方法 分析18例确诊为PE患者的超声心动图表现,与增强CT、肺动脉造影对照.结果 超声心动图直接检出主肺动脉及左右肺动脉近段血栓者4例,右室内血栓1例;具有右心负荷过重超声征象者15例,增强CT或肺动脉造影确诊为PE;TTE大致正常者3例,CT或肺动脉造影提示为肺段或亚段栓塞.结果 TTE可发现主肺动脉、左右肺动脉干内血栓直接提示PE,或根据右心负荷过重表现并结合临床表现间接提示PE可能,但对肺段或亚段栓塞TTTE不能作出或排除诊断.     

急性肺动脉栓塞56例心脏超声心动图表现分析

目的 探讨经胸超声心动图对急性肺动脉栓塞的诊断价值.方法 分析56例诊断为急性肺动脉栓塞患者的经胸超声心动图表现,与肺动脉造影、肺核素扫描及计算机体层摄影对照.结果 超声直接检出主肺动脉及左右肺动脉和右房内血栓30例;根据右心增大,右心负荷过重超声征象及结合有下肢静脉血栓提示肺动脉栓塞可能的有5例,有右心负荷过重超声考虑为右室心肌病的4例,超声考虑原发性肺动脉高压的8例,余9例超声检查大致正常,只有三尖瓣返流不可明确诊断,后经CT或核素肺灌注/通气扫描提示为肺段或亚段栓塞.结论 经胸超声心动图可发现主肺动脉、左右肺动脉干内血栓直接提示肺动脉栓塞,或根据右心负荷过重表现并结合临床表现间接提示肺栓塞的可能,但对肺段或亚段栓塞超声不能作出或排除诊断.     

肺动脉栓塞的超声心动图诊断价值分析

目的:分析超声心动图在肺动脉栓塞(PE)诊断中的应用价值.方法:常规经胸超声心动图检查26例PE病例,估测肺动脉压.结果:1例直接检出左肺动脉起始部团块状栓子,溶栓治疗20天后消失;18例具有右心负荷过重表现,核素肺灌注/通气扫描及CT均提示为一侧大面积栓塞或双肺多发栓塞.7例无明显异常,核素肺灌注/通气扫描提示为肺段栓塞.结论:超声心动图能直接发现肺动脉及分支内栓子,观察右心室负荷情况,尤其在急诊床旁检查,对PE是一个有价值的诊断和鉴别诊断的手段.     

超声在肺动脉栓塞诊断中的应用价值

目的 探讨经胸超声心动图（TTE）对肺动脉栓塞诊断中的应用价值。方法 对15例临床疑诊肺动脉栓塞患者进行了TTE检查和下肢深静脉超声检查，并与CT结果对照。结果 超声心动图发现8例肺动脉内血栓直接征象，11例右心系统形态改变，11例肺动脉收缩压升高。周围血管超声检出合并下肢静脉血栓12例。所有结果经CT证实。结论 超声心动图技术在检出右心系统和肺动脉内血栓，评价肺栓塞的血流动脉动力学改变具有重要的意义。     

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.     

超声检查在肺动脉栓塞诊断中的临床价值

目的 探讨超声检查在肺动脉栓塞诊断中的临床价值.方法 86例经CT、核素扫描以及肺动脉造影确诊的肺栓塞病例,同时行超声心动图和下肢深静脉超声检查.结果 超声心动图发现2例右房或肺动脉内血栓直接征像,58例右心系统形态改变及肺动脉压升高等间接征像.周围血管超声检出合并下肢深静脉血栓52例.结论 超声检查发现肺动脉栓塞直接或间接征像可以明确诊断或疑似诊断,所以对临床疑诊肺栓塞患者必须做具有诊断和筛查临床价值的超声心动图和下肢深静脉超声检查.     

超声心动图前列腺素E1试验诊断急性肺动脉栓塞的研究

目的探讨超声心动图评价前列腺素E1（PGE1）试验在急性肺动脉栓塞（APE）诊断中的应用价值。方法采用经胸超声心动图（TTE）检查泰安市中心医院2006年7月至2008年2月疑诊APE患者,顺序选取符合肺动脉高压、三尖瓣反流、疑诊APE的患者56例,TTE观测记录静脉注射PGE,前、即刻、5min、10min、30min时点患者肺动脉收缩压（PASP）数值,以静脉注射PGE,前PASP作为基线,注射后四个时点中任何一点PASP较基线下降幅度〈5mmHg为阳性。PASP较基线下降幅度1〉5mmHg为阴性。以螺旋CT肺动脉造影和（或）核素肺灌注扫描检查为诊断标准,通过ROC曲线评价TTE PGE1试验诊断APE敏感性、特异性。结果56例疑诊APE患者中检出APE患者36例（APE组）,非PE患者20例（NPE组）。注射即刻、5min、10min、30min时,该试验诊断APE的敏感性、特异性分别为77．8％、10．0％,72．2％、30．0％,88．9％、30．0％,88．9％、60．0％。结论1TTE PGE1试验是一种安全、方便、敏感性高的筛查诊断APE的方法。应用PGE,静脉注射30min时超声心动图试验筛查APE具有一定的可行性。     

多普勒超声心动图对急性肺动脉栓塞的诊断特点及分析

目的应用多普勒超声心动图分析无心肺基础病变急性肺动脉栓塞(PE)患者肺动脉血流频谱特点及对PE的诊断价值.方法应用多普勒超声心动图检测无心肺基础病变的急性PE患者肺动脉血流频谱曲线,与肺动脉造影、肺核素扫描及血气分析对照.结果多普勒超声检测17例发病2h至11d[平均(5.1±7.7)d]PE患者肺动脉血流频谱曲线,14例频谱曲线形态呈现双峰,表现高阻力低灌注的特点.计算收缩早期峰时明显小于收缩中晚期峰时,其比值平均0.56±0.16.收缩中晚期血流速度明显减低[(37.5±10.9)cm/svs(70.4±23.8)cm/s],早期峰时速度与收缩晚期速度比值1.67±0.26.早期血流加速时间(AT)及血流减速时间(DT)明显缩短[分别为(40.8±9.7)ms,(57.3±12.3)ms].15例检出三尖瓣反流,反流压差＞30mmHg[(58.1±18.7)mmHg],3例发现右心系统血栓的直接证据.出现肺动脉血流高阻力低灌注特征的14例PE患者经肺动脉造影和(或)肺通气灌注扫描证实为肺动脉主干或主支中至大块血栓栓塞.17例PE患者均出现急性肺源性心脏病表现.结论多普勒超声心动图检测中至大块急性PE肺动脉血流频谱曲线,呈现高阻力低灌注的双峰特征,对快速早期提示急性PE具有重要的临床应用价值.     

多普勒超声检测肺动脉分支血流对评估急性肺血栓栓塞症的意义

目的 应用多普勒超声心动图分析急性肺血栓栓塞症（APE）患者左右肺动脉分支血流频谱特点及对APE栓塞部位的评估意义。 方法 利用多普勒超声检测32例正常对照者（组Ⅰ）及42例大面积或次大面积APE患者肺动脉主干及其左右分支血流频谱。其中左侧肺动脉栓塞为主者19例（组Ⅱ），右侧肺动脉栓塞为主者11例（组Ⅲ），双侧肺动脉栓塞者12例（组Ⅳ）。 结果 各组APE患者肺动脉及左、右栓塞分支血流速度及速度时间积分（VTI）减低，加速时间缩短（P〈0．05）；组Ⅱ左、右肺动脉VTI比值及左肺动脉与主干VTI比值减低（P〈0．05）；组Ⅲ右肺动脉与主干VTI比值减低（P〈0．05）。 结论 多普勒超声检测APE患者肺动脉主干及其左、右分支血流频谱，对快速早期提示APE栓塞部位及程度具有显著的临床应用价值。     

超声心动图对肺栓塞诊断价值的研究

目的　探讨经胸超声心动图 (TTE)和经食管超声心动图 (TEE)对肺栓塞的诊断价值。方法　对10例临床疑诊肺栓塞患者进行了TTE和TEE检查 ,并与CT结果对照 ,其中 4例患者进行了治疗后TEE随访。结果　 10例患者右心房内径 (5 7± 9)mm ,右心室内径 (3 4± 5 )mm ,肺动脉收缩压 (91± 19)mmHg(1mmHg=0 .13 3kPa) ,所有患者均有中度 -重度三尖瓣反流。检出右肺动脉内活动性血栓 2例 ,附壁血栓 2例 ,右心室活动性血栓 2例 ,左肺动脉活动性血栓 3例 ,附壁血栓 1例。 10例患者中 4例为左肺动脉或右肺动脉远段血栓 ,由TEE检出。所有结果经CT或手术证实。溶栓加抗凝治疗 3例 ,手术治疗 1例 ,2 0d～ 3个月后随访TEE ,肺动脉内血栓明显缩小或消失 ,肺动脉压力下降。结论　超声心动图技术在检出右心系统和肺动脉内血栓、明确肺栓塞的临床类型、评价肺栓塞的血流动力学改变和随访治疗效果等方面具有重要价值 ;TEE是检出左右肺动脉远段血栓的可靠方法     

亚秒级螺旋CT肺动脉造影检测段与亚段肺动脉

目的评价亚秒级螺旋CT血管造影检测段与亚段肺动脉的能力及分析不同观察者间评阅图像的变异程度.方法对20名非胸肺和肺动脉疾病临床患者螺旋CT肺动脉造影(CT pulmonary angiography;CTPA)进行回顾性研究,共分析400个段动脉和800个亚段肺动脉.由两名具有不同临床经验的放射医师分别阅读图像,测量主肺动脉强化程度,记录显示清晰的段与亚段肺动脉,评价其显示情况,分析不同医师所得结果之间的相关性.结果97.5%的肺段动脉和77.5%亚段肺动脉显示清晰,观察者间一致性好(K=0.68).主肺动脉平均CT值为278±30Hu.结论亚秒级螺旋CTPA能清晰显示段与亚段肺动脉,可用于外周型肺动脉栓塞的诊断.     

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.     

双源CT在评价肺栓塞中的价值

目的 探讨双源CT在诊断肺栓塞中的价值.方法 2008年5月-2010年12月纳入50例可疑肺栓塞患者,使用双源CT进行肺动脉血管增强扫描,对图像行三维重建,分析栓塞部位、栓子形态、肺内、心脏及胸腔改变等.结果 44例确殄肺栓塞,发现肺栓塞共260处,最常见于右肺下叶动脉28例(63.0%),其次于右肺动脉22例(50...     

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。     

超声心动图急性肺栓塞溶栓治疗的评估

目的应用超声心动图技术观察急性肺栓塞患者溶栓抗凝治疗前后肺动脉栓子、右心结构及收缩功能的改变。方法前瞻性非随机对照研究,对2002年12月至2006年4月间经肺动脉CT或肺血管造影证实的30例急性肺栓塞患者行溶栓治疗,应用经胸超声心动图观察治疗前、治疗后24～30h、1个月的肺动脉栓子、主肺动脉及其分支内径、右房室内径,右室前壁运动幅度、右室舒张末期容积、右室射血分数,三尖瓣返流、肺动脉收缩压等指标。结果30例急性肺动脉栓塞患者溶栓治疗24～30h后右房室结构明显改善,表现为右房长径及横径、右室前后径及横径、主肺及右肺动脉内径、右室舒张末期容积与治疗前比较明显回缩(P<0.01),右室前壁运动幅度、右室射血分数有所增加(P<0.01),肺动脉收缩压明显下降(P<0.01);治疗后1个月后右房室大小、主肺及右肺动脉内径、右室舒张末期容积、右室前壁运动幅度及肺动脉收缩压等仍有恢复(P<0.05或P<0.01)。5例患者主肺动脉和/或右、左肺动脉内检出栓子,溶栓后栓子逐渐消失。结论超声心动图可动态、实时、无创评价急性肺动脉栓塞溶栓治疗效果,尤对血栓的溶解、右房室结构、右室超负荷及肺动脉高压的变化有独到的价值。     

Accuracy of single-detector spiral CT in the diagnosis of pulmonary embolism: a prospective multicenter cohort study of consecutive patients with abnormal perfusion scintigraphy.

BACKGROUND: Spiral computed tomography (CT) has emerged as a potentially conclusive diagnostic test to exclude pulmonary embolism (PE) in patients with non-high probability scintigraphy and is already widely used-sometimes as the sole primary diagnostic test in the diagnosis of suspected PE. Its true sensitivity and specificity has, however, not been evaluated previously in a large cohort of consecutive patients. METHODS: In a multicenter prospective study 627 consecutive patients with clinically suspected PE were studied. Patients with normal perfusion scintigraphy were excluded from further analysis. Single-detector spiral CT scanning and ventilation scintigraphy were then performed in all patients to diagnose PE, while pulmonary angiography was performed as the gold standard. The only exceptions were those patients who had both a high-probability VQ scan and a CT scan positive for PE: these patients were considered to have PE and did not undergo additional pulmonary angiography. All imaging tests were read by independent expert panels. RESULTS: Five hundred and seventeen patients were available for complete analysis. The prevalence of PE was 32%. Spiral CT correctly identified 88 of 128 patients with PE, and 92 of 109 patients without PE, for a sensitivity and specificity of 69%[95% confidence interval (CI) 63-75] and 84% (95% CI 80-89), respectively. The sensitivity of spiral CT was 86% (95% CI 80-92) for segmental or larger PE and 21% (95% CI 14-29) in the group of patients with subsegmental PE. CONCLUSION: The overall sensitivity of spiral CT for PE is too low to endorse its use as the sole test to exclude PE. This holds true even if one limits the discussion to patients with larger PE in segmental or larger pulmonary artery branches. We conclude that, in patients with clinically suspected PE and an abnormal perfusion scintigraphy, single-slice detector spiral CT is not sensitive enough to be used as the sole test to exclude PE.     

Transesophageal echocardiography for the diagnosis of pulmonary embolism with acute cor pulmonale: a comparison with radiological procedures

Objective: The goal of the study was to assess prospectively the value of transesophageal echocardiography (TEE) for the diagnosis of massive pulmonary embolism complicated by acute cor pulmonale. Design: A prospective study conducted on 44 consecutive patients. Setting: A general intensive care unit (ICU) of a university hospital. Patients and methods: Between May 95 and October 96, 44 consecutive patients with clinically suspected acute pulmonary embolism underwent transthoracic echocardiography (TTE), completed by TEE when acute cor pulmonale was present (30 patients). The results of the echocardiographic studies were compared with radiological investigations by helical CT or contrast angiography. Results: The high sensitivity and specificity of the presence of acute cor pulmonale on TTE for the diagnosis of pulmonary embolism was confirmed. Nineteen patients only underwent TEE. The sensitivity and the specificity of TEE in detecting a proximal pulmonary embolism were 84 % and 84 %, respectively. Its main limitation concerned the left pulmonary artery, in which only one thrombus was visualized by TEE whereas six were present on helical CT, and lobar pulmonary arteries which could not be visualized with TEE. Thus, the overall sensitivity of TEE for the detection of pulmonary embolism with acute cor pulmonale was only 58 %. Conclusion: In comparison with radiological procedures, TEE had limited accuracy for detecting pulmonary embolism with acute cor pulmonale. When the pulmonary embolism was located in the main or right pulmonary artery, TEE could clarify the diagnosis within a few minutes without further invasive diagnostic procedures. However, a negative TEE did not exclude left proximal or lobar pulmonary embolism. Received: 28 April 1997 Accepted: 28 November 1997     

Diagnosis of pulmonary embolism by acute right heart morphologic and hemodynamic changes observed during exercise stress echocardiography.

In addition to the conventional means of diagnosing pulmonary embolism, resting echocardiography has sometimes been useful. We describe the case of a patient with a normal resting transthoracic echocardiogram, but with a markedly abnormal posttreadmill exercise echocardiogram revealing acute right ventricular dilatation, marked ventricular septal shift, and acute pulmonary hypertension. Pulmonary embolism was suspected and subsequently confirmed by chest computed tomographic angiography.     

超声心动图和CT血管造影诊断肺动脉闭锁的价值

目的对比分析经胸超声心动图（TTE）和多层螺旋CT血管造影（MSCTA）在术前评价肺动脉闭锁（PA）的价值。方法回顾性分析26例经手术证实的肺动脉闭锁患儿的TTE和MSCTA资料,对比两者对PA位置、动脉水平分流、房室间隔完整性、三尖瓣及右心室发育情况、大动脉位置及其与心脏连接关系的诊断价值。结果依据手术结果,26例PA患者中室间隔完整型PA6例、室间隔缺损型PA20例。肺动脉瓣闭锁13例、肺动脉主干闭锁11例、左／右肺动脉起始段闭锁2例。肺循环由动脉导管单一供血22例、由动脉导管和体一肺动脉侧支双重供血4例。TTE和MSCTA对PA及其位置的诊断与手术一致。TTE漏诊体-肺动脉侧支2例、主动脉骑跨3例、大动脉转位1例、永存左上腔静脉1例。MSCTA漏诊房间隔缺损2例、卵圆孔未闭1例、漏斗部室间隔缺损2例、三尖瓣闭锁合并右心室发育不良1例。MSCTA、TTE对心内畸形诊断的准确率分别为83％（29／35）、100％（35／35）;对心外畸形诊断的准确率分别为100％（49／49）、86％（42／49）;总的诊断准确率分别为93％（78／84）、92％（77／84）。MSCTA和TTE诊断心内、心外畸形准确率间差异均有统计学意义（Fisher确切概率法,P=0．025、0．012）,但两者对心内、心外畸形总的诊断准确率间差异无统计学意义（x^2=0．083,P=0．773）。结论TTE对心内畸形诊断的准确率优于MSCTA,而在大动脉位置关系及体．肺动脉侧支评价上存在局限性,联合MSCTA可提高诊断准确率。     

Diagnosis and management of subsegmental pulmonary embolism

Summary. Introduction: Although the advent of multi‐detector row computed tomography (CT) has enabled better visualization of subsegmental pulmonary (SSP) arteries, SSP embolism is of uncertain clinical significance. We aimed at answering the following questions: Is spiral CT an accurate method to detect SSP embolism? How are subsegmental perfusion defects managed in outcome studies including spiral CT? What are the main characteristics and outcomes of patients in whom CT detects isolated subsegmental defects? Methods: We performed a Medline search on July 1, 2004, using the keywords ‘pulmonary embolism’ and ‘computed tomography’. We limited our search to English language prospective studies comparing CT to pulmonary angiography, and to prospective outcome studies including CT in a diagnostic strategy, with at least a 3‐month follow‐up. Results: Fourteen studies comparing CT to pulmonary angiography, and five prospective management studies using CT were retrieved. The sensitivity of single‐detector CT for detecting subsegmental defects compared with pulmonary angiography was low (25%). The proportion of isolated SSP images was significantly higher in management studies using multi‐detector CT (17 of 770 scans, 2.2%) compared with those using single‐detector CT (22 of 2232, 1.0%; P = 0.01). No straightforward attitude regarding anticoagulation therapy for isolated subsegmental defects emerged from the available literature. Finally, important clinical differences were found between patients having subsegmental and segmental or more proximal defects. Conclusions: These findings underline the uncertainty regarding the clinical significance of SSP embolism, and the management of patients with such findings.