非对比剂增强流入敏感翻转恢复序列磁共振肺动脉成像诊断肺栓塞的临床应用

目的探讨非对比剂增强流入敏感翻转恢复序列(IFIR)磁共振肺动脉成像诊断肺栓塞的临床应用价值。方法对36例临床怀疑肺栓塞患者进行IFIR扫描,在ADW4.6工作站上行最大密度投影(MIP)重建分析扫描数据。结果本组36例患者成功完成扫描,图像质量均可满足诊断。其中2例呼吸偶发不规律,经再次进行呼吸训练完成扫描。30例诊断为肺栓塞,其中段级肺栓塞8例;余6例排除肺栓塞。全部病例最终诊断均经CT肺血管成像(CTPA)及临床溶栓治疗有效所证实。肺栓塞患者受累肺动脉不同表现30例中,IFIR肺动脉成像显示腔内附壁性充盈缺损7例(23.3%),管腔闭塞17支(56.7%),管腔中央的轨道征6例(20.0%)。30例均被CTPA证实为肺栓塞。结论非对比剂增强IFIR肺动脉成像对诊断肺栓塞是一种有效的检查手段,其具有无创、无辐射及可重复性等优势,尤其适用于临床筛查。     

动态增强磁共振肺动脉造影在诊断肺动脉栓塞的价值

肺动脉栓塞(pulmonary embolism,PE)是由内源性或外源性栓子堵塞肺动脉引起肺循环障碍所致的一组病理生理综合征.其起病急,发病率、死亡率及误诊率均高,国内报告的材料误诊率达80%左右[1].国外有研究表明,动态增强磁共振肺动脉造影(dynamic contrast-enhanced MR pulmonary angiography,DCE-MRPA)是诊断PE较理想的非创伤性影像学检查方法,敏感性和特异性高[2].本次研究回顾性分析17例DCE-MRPA诊断PE的影像学资料.现报道如下.     

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。     

MRI血管成像与增强血管成像对后循环缺血的诊断价值

目的 探讨MRI血管成像(magnetic resonance angiography,MRA)与增强MRI血管成像(contrast-enhanced MRA,CE-MRA)诊断后循环缺血疾病的价值。方法 回顾性分析50例后循环缺血患者MRA及CE-MRA检查结果,比较2种方法图像质量、狭窄及闭塞血管数目差异。结果 CE-MRA的图像质量良好率(76%)高于MRA检查(46%)(P<0.05);CE-MRA检查椎-基底动脉多发性血管病变的阳性率48%(24/50)高于MRA检查28%(14/50)(P<0.05);CE-MRA显示椎动脉、基底动脉和大脑动脉后狭窄率分别为78%、30%、28%,MRA则显示狭窄率分别为62%、20%、18%,二者比较差异均有统计学意义(P<0.05)。结论 MRA及CE-MRA均可为后循环缺血提供诊断依据,但CEMRA诊断效能优于常规MRA检查。     

MSCT与MR肺动脉成像对肺动脉栓塞的诊断价值

目的：比较多层螺旋CT肺动脉成像（MSCT pulmonary angiography,MSCTPA）及磁共振肺动脉成像（MR pulmonary angiography,MRPA）对肺动脉栓塞（Pulmonary embolism,PE）的诊断价值。方法：对50例拟诊为PE的患者,42例采用双源CT行肺动脉成像,观察肺动脉栓子的部位、数目、形态等直接征象,观察肺叶继发改变;8例行1.5T MRPA,其中3例补充行三维增强磁共振肺动脉成像（3D-CE-MRPA）检查,观察肺动脉栓子的特点。结果：42例中,MSCTPA共发现栓子657支,其中段以上栓子481支,包括中心型栓子176支、附壁型259支、完全阻塞型46支。间接征象包括马赛克征、肺梗死、胸腔积液、肺动脉增粗等。8例MRPA共诊断左、右肺动脉栓塞9支,叶肺动脉栓塞19支。非增强MR成像对肺段动脉栓塞诊断受到限制。3例行3D-CE-MRPA的患者中,段及以上及大部亚段肺动脉栓塞显示清楚。结论：MSCTPA能够方便、快捷、清楚地显示肺动脉栓子;MRI平扫可以发现肺叶动脉以上的栓子,肺段动脉栓子部分可见;3D-CE-MRPA可以发现肺段及大部分亚段肺动脉栓子,诊断效能接近CTPA。     

CTPA诊断肺动脉栓塞及快速预判严重程度的应用价值

目的:研究16排螺旋CT肺动脉造影(CT pulmonary angiography,CTPA)诊断肺动脉栓塞及预判严重程度的应用价值。方法:选取2017年1月—2020年12月在南通市通州区平潮中心卫生院疑诊肺动脉栓塞做过CTPA的患者43例,针对患者临床资料及影像检查开展回顾性分析,根据患者病情划分为危险组(20例)和非危险组(23例)。结果:危险组患者CTPA栓塞指数与肺段以上中央肺动脉受累比例高于非危险组,差异具有统计学意义(P <0.05);危险组患者横轴位肺动脉主干直径、肺动脉主干直径与升主动脉直径比值显著高于非危险组(P <0.05)。结论:针对疑诊肺动脉栓塞患者,采用CTPA检查,能够实现对患者肺动脉栓塞状况的直观判断,并快速预判肺栓塞严重程度,能够为临床诊治提供重要参考。     

低剂量CT结肠成像联合MRI在结直肠癌诊断中的价值分析

目的:探讨低剂量CT结肠成像联合MRI在结直肠癌诊断中的应用价值。方法:以我院2018年3月至2021年3月收治的70例疑似结直肠癌患者为研究对象,所有患者术前均接受低剂量CT结肠成像与MRI检查,最终以手术病理结果为诊断依据,不同检查方法的诊断结果、诊断效能及在TNM分期中的诊断准确率。结果:在70例疑似结直肠癌患者中,手术病理结果显示阳性60例,阴性10例。低剂量CT结肠成像阳性检出率为68.57%;MRI阳性检出率为74.29%;低剂量CT结肠成像联合MRI阳性检出率为82.86%,低剂量CT结肠成像联合MRI检查阳性检出率显著高于低剂量CT结肠成像与MRI单独检查,但没有差异性(P>0.05);低剂量CT结肠成像诊断敏感性、特异性、阳性预测值及阴性预测值分别为76.67%、80.00%、95.83%、63.64%;MRI诊断敏感性、特异性、阳性预测值及阴性预测值分别为85.00%、90.00%、98.08%、50.00%;低剂量CT结肠成像联合MRI诊断敏感性、特异性、阳性预测值及阴性预测值分别为96.67%、100.00%、100.00%、83.33%;低剂量CT结肠成...     

CT与MRI鉴别诊断肾上腺皮质腺瘤与嗜铬细胞瘤的价值研究

目的:探讨电子计算机断层扫描(CT)和磁共振成像(MRI)在肾上腺皮质腺瘤(ACA)与嗜铬细胞瘤(AP)鉴别诊断中的临床应用价值。方法:回顾收集2016年10月至2021年10月我院经手术病理证实ACA患者(67例)与AP患者(33例),且于病理确诊前完成CT与MRI检查。比较CT检查ACA与AP肿瘤直径、CT值。以病理检查结果作为金标准,比较CT与MRI及CT与MRI联合诊断的敏感性、特异性、准确性。结果:ACA肿瘤直径、平扫CT值、增强CT值均低于AP,差异有统计学意义(P<0.05)。CT诊断AP与ACA敏感性58.21%,特异性30.30%,准确性49.00%;MRI诊断敏感性74.63%,特异性54.55%,准确性68.00%;CT与MRI联合诊断敏感性88.06%,特异性78.79%,准确性85.00%;CT与MRI联合诊断ACA与AP敏感性、特异性、准确性高于单独CT、MRI,MRI诊断敏感性、特异性、准确性高于CT,差异均有统计学意义(均P<0.05)。结论:CT与MRI均可在鉴别诊断ACA与AP中发挥作用,其中,MRI优于CT,CT与MRI联合优于单独CT...     

冠状动脉旁路移植术后移植血管64排螺旋CT血管成像与选择性血管造影对比研究

目的:探讨64排螺旋CT血管成像对冠状动脉旁路移植血管诊断的准确性和应用价值。方法:对20例实施冠状动脉旁路移植5 a以上冠心病患者进行随访。冠状动脉及移植血管同时行64排螺旋CT血管成像和选择性血管造影,比较分析2种检查结果。结果:共移植血管58支。以选择性移植血管造影结果为标准,64排螺旋CT血管成像对移植血管闭塞诊断的敏感性为77.27%,特异性为97.22%,阳性预测值为94.44%,阴性预测值为87.50%,准确性为89.66%;对于闭塞加狭窄诊断的敏感性为81.48%,特异性为93.55%,阳性预测值为91.67%,阴性预测值为85.29%,准确性为87.93%。结论:64排螺旋CT血管成像对移植血管病变具有较高敏感性和特异性,可作为冠状动脉旁路移植手术后检查方法,尤其适用于选择性血管造影检查困难的移植血管。     

CT与MR血管造影在颅内动脉瘤诊断中的价值比较

目的:探讨CT与MR血管造影在颅内动脉瘤诊断中的应用价值。方法:以我院2019年1月至12月84例疑似颅内动脉瘤患者为研究对象,所有患者均接受CT与MR检查,最终以数字减影血管造影(DSA)作为诊断的金标准,比较不同检查方法的诊断效果。结果:在84例疑似患者中,经DSA检查确诊为颅内动脉瘤55例,CT检出颅内动脉瘤52例,MR检出颅内动脉瘤53例,CT检查的敏感性、特异性、准确性及阳性预测值分别为90.91%、93.10%、91.67%及96.15%,MR检查的敏感性、特异性、准确性及阳性预测值分别为89.09%、80.65%、88.10%及89.09%,CT与MR检查的诊断效能比较无统计学意义(P>0.05)。CT与MR检查在瘤体直径与瘤颈宽度上的测量结果比较无统计学差异(P>0.05),CT在直径<3mm动脉瘤中的检出率显著高于MR,两组方法比较差异性显著(P<0.05)。结论:CT与MR检查在颅内动脉瘤诊断中均有较高的应用价值,而CT更有利于检出直径较小的病灶,MR具备安全性高、无辐射的优点,临床上可根据患者的实际情况进行选择。     

Chinese multi-center study of lung scintigraphy and CT pulmonary angiography for the diagnosis of pulmonary embolism

To evaluate diagnostic value of the PISA-PED and PIOPED II criteria for lung scintigraphy and compare it with CT pulmonary angiography (CTPA) for the detection of pulmonary embolism (PE). Five hundred and forty-four consecutive patients with suspected PE were enrolled. All patients underwent lung ventilation/perfusion (V/P) scan, chest radiography, and CTPA. Two readers used the PIOPED II criteria, and 2 used the PISA-PED criteria for the interpretation of lung scintigraphy. CTPA scans were interpreted by two experienced radiologists. Lung scintigraphy and CTPA were categorized as PE present, absent or non-diagnostic. PE was present in 321 of 544 patients. Using PIOPED II criteria, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 85.1, 82.5, 88.1, and 78.4% respectively for V/P scan. Using PISA-PED criteria, sensitivity, specificity, PPV, and NPV were 86.0, 81.2, 86.8, and 80.1% respectively, and none was non-diagnostic. Sensitivity, specificity, PPV, and NPV were 81.7, 93.4, 94.9, and 77.3%, respectively for CTPA. PISA-PED interpretation has similar diagnostic accuracy to PIOPED II interpretation, does not have non-diagnostic scan, with lower cost and radiation, thus should be considered as a choice for patients with suspected PE.     

Contemporary diagnostics of pulmonary arterial embolism

Nowadays, computed tomography along with pulmonary angiography (CTPA) is a recognized method of assumed pulmonary embolism (PE) diagnostics; however, even in experienced centers, CTPA sensitivity varies between 58 and 95%. Computed tomography with contrast venography and femoral scanning aimed at the diagnostics of profound venous thromboembolism, is a useful addition to CTPA. Besides these methods, some other well-known diagnostic techniques may be used in complex PE diagnostics: ventilation-perfusion pulmonary scanning, the evaluation of PE probability by clinical manifestations (P. Wells method), and digital subtraction angiography.     

CTPA与V/Q扫描诊断肺栓塞的比较研究

目的以肺动脉造影为金标准,评价CT血管造影(CTPA)和肺通气灌注扫描(V/Q扫描)对肺栓塞的临床诊断价值.方法检索Cochrane图书馆、PubMed、Ovid数据库和中国期刊网中关于CTPA诊断肺栓塞的中英文文献,按照Cochrane协作网推荐的诊断试验的纳入标准筛选文献,提取纳入研究的特征信息.将入选研究和一项多中心的V/Q扫描的研究结果进行加权定量合并,计算汇总灵敏度和特异度及其95%可信区间,绘制汇总受试者工作特征曲线(SROC),计算曲线下面积.评价两种检查方法与肺动脉造影结果的一致性.结果 8篇评价CTPA的文献符合纳入标准.CTPA的汇总灵敏度和特异度分别为0.86和0.90,V/Q扫描的汇总灵敏度和特异度为0.82和0.60.二者的SROC曲线下面积(%)分别为94.43和81.90.CTPA与金标准肺动脉造影的诊断结果一致性较高.结论 CTPA诊断PE在准确性和确定性方面较V/Q扫描的价值高.鉴于CTPA的无创性及其与肺动脉造影结果的一致性,CTPA可作为肺动脉造影不能使用时的首选检查方法.     

Computed tomography pulmonary angiography in the diagnosis of acute pulmonary embolism in the emergency department

This study was undertaken to evaluate the use of computed tomography pulmonary angiography (CTPA) in patients with pulmonary embolism (PE) who were followed in the emergency department (ED). The files and computer records of 850 patients older than 16 years of age who were seen in the Hacettepe University Hospital ED between April 10, 2001, and December 1, 2005, and who required CTPA for PE prediagnosis and/or another diagnosis, were studied retrospectively. PE was identified by CTPA in 9.4% of 416 women and in 5.8% of 434 men. A significant difference (P< .05) was noted in the women and men in whom PE was detected. The mean age of the patients was 58.13±17.88 y (range, 16–100 y). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for clinical susceptibility to PE among patients who underwent CTPA were assessed at 95.3%, 48.2%, 13%, and 99.2%, respectively. CTPA was done for different reasons: aortic aneurysm dissection (n=1), cough distinctive diagnosis (n=1), dyspnea distinctive diagnosis (n=6), chest pain distinctive diagnosis (n=3), PE prediagnosis (n=51), and other reasons (n=2). Also, sensitivity, specificity, PPV, and NPV were found to be 95.4%, 16.2%, 14.4%, and 96%, respectively, for D-dimer. CTPA, which is accessible on a 24-h basis in the ED, is a valuable tool for the diagnosis of PE.     

Subsegmental pulmonary embolism diagnosed by computed tomography: incidence and clinical implications. A systematic review and meta‐analysis of the management outcome studies

Summary. Background: Multiple‐detectors computed tomographic pulmonary angiography (CTPA) has a higher sensitivity for pulmonary embolism (PE) within the subsegmental pulmonary arteries as compared with single‐detector CTPA. Multiple‐detectors CTPA might increase the rate of subsegmental PE diagnosis. The clinical significance of subsegmental PE is unknown. We sought to summarize the proportion of subsegmental PE diagnosed with single‐ and multiple‐detectors CTPA and assess the safety of diagnostic strategies based on single‐ or multiple‐detectors CTPA to exclude PE. Patients and methods: A systematic literature search strategy was conducted using MEDLINE, EMBASE and the Cochrane Register of Controlled Trials. We selected 22 articles (20 prospective cohort studies and two randomized controlled trials) that included patients with suspected PE who underwent a CTPA and reported the rate of subsegmental PE. Two reviewers independently extracted data onto standardized forms. Results: The rate of subsegmental PE diagnosis was 4.7% [95% confidence interval (CI): 2.5–7.6] and 9.4 (95% CI: 5.5–14.2) in patients that underwent a single‐ and multiple‐detectors CTPA, respectively. The 3‐month thromboembolic risks in patients with suspected PE and who were left untreated based on a diagnostic algorithm including a negative CTPA was 0.9% (95% CI: 0.4–1.4) and 1.1% (95% CI: 0.7–1.4) for single‐ and multiple‐detectors CTPA, respectively. Conclusion: Multiple‐detectors CTPA seems to increase the proportion of patients diagnosed with subsegmental PE without lowering the 3‐month risk of thromboembolism suggesting that subsegmental PE may not be clinically relevant.     

急性肺栓塞CT肺动脉成像的研究进展

目前,CT肺动脉成像（CTPA）被认为是临床诊断急性肺栓塞（PE）的“金标准”。CTPA为诊断急性外周性PE提供了多方面的依据。但CTPA诊断急性外周性PE仍存在较大困难。目前CT辐射剂量及对比剂负荷为研究热点。本文对急性PE的CTPA诊断（尤其是外周性PE）、预后评估、CTPA技术进展等进行综述。     

Safety of ruling out acute pulmonary embolism by normal computed tomography pulmonary angiography in patients with an indication for computed tomography: systematic review and meta-analysis

Introduction : Several outcome studies have ruled out acute pulmonary embolism (PE) by normal computed tomography pulmonary angiography (CTPA). We performed a meta-analysis in order to determine the safety of this strategy in a specific group of patients with a strict indication for CTPA, that is, 'likely' or 'high' clinical probability for PE, an elevated D-dimer concentration, or both. Methods : Studies that ruled out PE by normal CTPA, with or without subsequent normal bilateral compression ultrasonography (CUS), in patients with a strict indication for CTPA, were searched for in Medline, EMBASE, Web of Science and the Cochrane dataset. The primary endpoint was the occurrence of (fatal) venous thromboembolism (VTE) in a 3-month follow-up period. Results : Three studies were identified that excluded PE by CTPA alone (2020 patients), and three studies that performed additional CUS of the legs after normal CTPA (1069 patients). The pooled incidence of VTE at 3 months was 1.2% [95% confidence interval (CI) 0.8–1.8] based on a normal CTPA result as a sole test, and 1.1% (95% CI 0.6–2.0) based on normal CTPA and negative CUS findings, resulting in negative predictive values of 98.8% (95% CI 98.2–99.2) and 98.9% (95% CI 98.0–99.4), respectively. This compares favorably with the VTE failure rate after normal pulmonary angiography (1.7%, 95% CI 1.0–2.7). The risk of fatal PE did not differ between the diagnostic strategies (0.6% vs. 0.5%). Conclusion : A normal CTPA result alone can safely exclude PE in all patients in whom CTPA is required to rule out this disease. There is no need for additional ultrasonography to rule out VTE in these patients.     

双源双能量CT诊断周围型肺动脉栓塞的价值

目的 探讨双源双能量CT对周围型肺动脉栓塞的诊断价值.方法 从临床怀疑肺动脉栓塞(PE)并行双源双能量CT肺动脉成像的患者中选择周围型PE患者36例(98个栓子)纳入本研究.运用Syngo.via工作站对双源双能量CT扫描数据进行CT肺动脉血管成像(CTPA)和CT双能量Lung Analysis后处理.记录PE的栓塞...     

Value of CT pulmonary angiography to predict short-term outcome in patient with pulmonary embolism

To evaluate the role of CT pulmonary angiography (CTPA) in the assessment of pulmonary embolism (PE) severity and the related CT cardiac changes, reflecting the clinical status of the patients and predicting the outcome. A prospective study of 184 patients presented with suspicious acute PE. All patients underwent CTPA followed by ECHO. Pulmonary artery obstructive index (PAOI) using Qanadli Score was calculated and cardiac changes recorded. The patients’ outcome was followed up for 30 days. Only 150 patients completed the study; 26.7% needed ICU admission while 13.3% died during follow-up. There was a significant relationship between the PAOI and the risk classification, right ventricular dysfunction (RVD) diagnosed by ECHO and the patients’ short outcome. We found PAOI cut off value 45% for mortality and 35% for ICU admission and 27.5% for RVD with 60, 75 and 90% sensitivity and 80, 73.3 and 68.6% specificity respectively. CT RV/LV ratio was the most sensitive parameter to predict RV dysfunction followed by pulmonary artery diameter. CTPA is not only used for diagnosis but also to assess the severity of PE, the effect on the right ventricular function and subsequently the need for ICU admission and prediction of the outcome.     

广西地区13家综合医院肺栓塞诊断技术分析

目的 了解各种肺栓塞(PE)诊断技术在诊断PE中的应用.方法 对广西地区13家三级甲等综合医院1995年至2007年PE病例的诊断方法进行回顾性调查分析.根据临床表现以及普通检查诊断的PE病例为临床诊断病例,根据特殊影像检查结果或尸体解剖诊断的病例为确诊病例.比较各种PE诊断方法在诊断为PE患者中的比例以及不同年份各种诊断方法所占比例.结果 1995年至2007年13家医院诊断为PE患者460例,其中确诊病例237例(占51.52%),临床诊断病例223例(占48.48%).2002年至2007年确诊病例占同期PE病例的55.13%,较1995年至2001年14.63%明显提高(X~2=24.522,P<0.01).237例确诊病例中,17例由2项检查确诊,由肺动脉造影、CT肺动脉造影、超声检查、磁共振成像以及尸体解剖各诊断27例(11.39%)、214例(90.30%)、6例(2.53%)、5例(2.11%)和2例(0.84%),没有肺通气灌注显像确诊病例.2003年以后采用CT肺动脉造影广西地区确诊PE所占比例升高.其他检查技术则略有下降.结论 CT肺动脉造影是广西地区诊断PE的首选方法,其他诊断技术的临床应用有待加强.