Fluorescence visualization of the intersegmental plane by bronchoscopic instillation of indocyanine green into the targeted segmental bronchus: determination of the optimal settings

ObjectiveTo determine the appropriate amount of indocyanine green for bronchial insufflation.MethodsWe enrolled 20 consecutive patients scheduled for anatomical segmentectomy in the Kochi Medical School Hospital. After inducing general anesthesia, 6 to 60 mL of 200-fold-diluted indocyanine green (0.0125 mg/mL) was insufflated into the subsegmental bronchi in the targeted pulmonary segmental bronchus. The volume of the targeted pulmonary segments was calculated using preoperative computed tomography. Fluorescence spread in the segmental alveoli was visualized using a dedicated near-infrared thoracoscope.ResultsThe targeted segment was uniformly visualized by indocyanine green fluorescence in 16/20 (80.0%) cases after insufflating indocyanine green. A receiver operating characteristic curve indicated that the area under the curve was 0.984; the optimal cut-off volume of diluted indocyanine green for insufflation was 8.91% of the calculated targeted pulmonary segment volume.ConclusionsThe setting for indocyanine green insufflation was optimized for near-infrared fluorescence image-guided anatomical segmentectomy. By injecting the correct amount of indocyanine green, fluorescence-guided anatomical segmentation may be performed more appropriately.     

Thoracoscopic segmentectomy and lobectomy assisted by three-dimensional computed-tomography bronchography and angiography for the treatment of primary lung cancer

BACKGROUNDAnatomical segmentectomy has been proposed as a substitution for lobectomy for early-stage lung cancer. However, it requires technical meticulousness due to the complex anatomical variations of segmental vessels and bronchi.AIMTo assess the safety and feasibility of three-dimensional computed-tomography bronchography and angiography (3D-CTBA) in performing video-assisted thoracoscopic surgery (VATS) for lung cancers.METHODSIn this study, we enrolled 123 patients who consented to undergo thoracoscopic segmentectomy and lobectomy assisted by 3D-CTBA between May 2017 and June 2019. The image data of enhanced computed tomography (CT) scans was reconstructed three-dimensionally by the Mimics software. The results of preoperative 3D-CTBA, in combination with intraoperative navigation, guided the surgery.RESULTSA total of 59 women and 64 men were enrolled, of whom 57 (46.3%) underwent segmentectomy and 66 (53.7%) underwent lobectomy. The majority of tumor appearance on CT was part-solid ground-glass nodule (pGGN; 55.3%). The mean duration of chest tube placement was 3.5 ± 1.6 d, and the average length of postoperative hospital stay was 6.8 ± 1.8 d. Surgical complications included one case of pneumonia and four cases of prolonged air leak lasting > 5 d. Notably, there was no intraoperative massive hemorrhage, postoperative intensive-care unit stay, or 30-d mortality. Preoperative 3D-CTBA images can display clearly and vividly the targeted structure and the variations of vessels and bronchi. To reduce the risk of locoregional recurrence, the application of 3D-CTBA with a virtual 3D surgical margin help the VATS surgeon determine accurate distances and positional relations among the tumor, bronchial trees, and the intersegmental vessels. Three-dimensional navigation was performed to confirm the segmental structure, precisely cut off the targeted segment, and avoid intersegmental veins injury.CONCLUSIONVATS and 3D-CTBA worked in harmony in our study. This combination also provided a new pattern of transition from lesion-directed location of tumors to computer-aided surgery for the management of early lung cancer.     

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.     

光谱CT肺动脉成像定性诊断肺动脉栓塞及定量评估肺组织灌注

目的 观察光谱CT肺动脉成像(SCTPA)定性诊断肺动脉栓塞(PE)和定量评估肺组织灌注的价值。方法 回顾性分析37例临床诊断PE患者的CTPA资料,观察常规CTPA及SCTPA后处理图像,后者包括40 keV虚拟单能量图(VMI_{40 keV})、碘密度图(IDI)与有效原子序数(Z-eff)图的融合图及电子密度图(EDI);记录2种图像中肺段动脉、肺亚段及以下动脉内的栓子数量和位置,对比其中相应肺灌注缺损区与对侧相应正常肺实质区常规CT值、碘密度(ID)、Z-eff及电子密度(ED)的差异;针对差异有统计学意义的sCTPA参数绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评估其区分PE肺灌注缺损区与正常肺实质的效能。结果 37例中,仅以常规CTPA检出37个栓子,其中26个位于肺段动脉、11 个位于肺亚段及以下动脉;之后结合SCTPA后处理图像额外检出1个肺段动脉和2个肺亚段以下动脉内栓子。全部40个栓子对应肺灌注缺损区常规CT值高于、ID及Z-eff均低于对侧正常肺实质区(P均<0.01),而ED与正常肺实质区差异无统计学意义(P=0.54)。以常规CT值区分肺灌注缺损区与正常肺实质区的敏感度、特异度分别为42.50%及87.50%,以ID及Z-eff区分的敏感度分别为95.00%、97.50%,特异度均为100%。ID及Z-eff的AUC均为0.99,均高于常规CT值(0.65,Z=5.56、5.53,P均<0.01),而 ID与Z-eff的AUC差异无统计学意义(Z=0.71,P=0.48)。结论 利用SCTPA可提高PE检出率及定量评估肺组织灌注;根据ID及Z-eff可有效区分肺灌注缺损区与正常肺实质。     

实时三维超声心动图节段分析法判定心房、心室及大动脉关系

目的 探讨实时三维超声心动图(RT-3DE)全容积显像在心脏节段分析中的应用.方法 采集97例患者的心尖四腔位的RT-3DE全容积图,在三个方位(冠状位、矢状位、水平位)、六个方向对图像进行剖切、分析,寻找分辨心房、心室、房室连接及大动脉连接的重要剖切方向及观察方向.结果 心尖四腔全容积图经冠状、矢状及水平三个方位的六个方向的剖切可清晰显示心心房、心心室、房室连接及大动脉连接.结论 心尖RT-3DE的全容积图像能为临床提供多元信息,满足心脏节段分析的需要.     

HRCT定量观察慢性阻塞性肺疾病患者支气管重构

目的 观察不同临床表型慢性阻塞性肺疾病(COPD)患者肺段和亚段支气管重构的差异。 方法 COPD患者76例,正常对照者30名(正常组),均接受胸部HRCT检查。对双上肺尖后段及亚段、双下肺后基底段及亚段支气管进行定量分析,分别测量4支段和4支亚段支气管的壁厚度(WT)、腔内径(Din)、壁面积(WA)和壁面积百分比(WA%),比较组间各指标差异。 结果 76例COPD患者分为支气管炎型(A组,41例)和肺气肿型(B组,35例)2种临床表型。A组表现为支气管管壁增厚和管腔变窄,以亚段支气管明显;B组表现为肺密度减低和肺气肿,支气管壁增厚不明显或轻度增厚。A、B两组段和亚段支气管WT大于正常组(P<0.05),段支气管Din小于正常组,A组亚段支气管Din小于正常组,差异有统计学意义(P<0.01),A、B两组间差异也有统计学意义(P<0.05)。A组段和亚段支气管WA大于正常组(P<0.05)。A、B两组段和亚段支气管WA%大于正常组(P<0.05),亚段支气管WA%显著大于段支气管(P<0.05)。 结论 HRCT能够检测段和亚段支气管重构,有助于诊断COPD患者临床表型。     

多层螺旋CT诊断完全型肺静脉异位引流

目的 探讨多层螺旋CT(MSCT)在完全型肺静脉异位引流(TAPVC)诊断中的应用。方法 分析25例经手术证实的TAPVC患者MSCT增强扫描图像及多平面重建、曲面重建、最大密度投影、容积再现图像。结果 MSCT 正确诊断2 5例TAPVC,准确率100%。本组病例均伴有心房畸形,MSCT诊断房间隔缺损和室间隔缺损的准确率分别为83.33%(15/18)和81.82%(9/11)。对单心房、单心室、大动脉转位、右室双出口、动脉导管未闭、右心房异构、三尖瓣闭锁、肺动脉瓣下狭窄、肺动脉闭锁、主动脉弓发育不良及肺动脉高压,MSCT与手术结果完全符合。结论 MSCT对于TAPVC及其合并的其他畸形具有重要的诊断价值。     

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.     

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.     

慢性阻塞性肺疾病患者小气道重塑及肺叶水平肺气肿的CT定量分析及其与肺功能的相关性研究

目的 MSCT定量分析慢性阻塞性肺疾病(COPD)患者小气道重塑及肺叶水平气肿指数(EI),并探讨小气道定量参数分别与肺功能、气肿指数的相关性。方法60例COPD患者接受肺功能检查后行吸气相MSCT扫描,应用COPD自动分析软件获得右肺上叶尖段(RB1)、右肺中叶外侧段(RB4)、右肺下叶后基底段(RB10)、左肺上叶尖后段(LB1)、左肺下叶后基底段(LB10)第4~6级平均支气管腔内径(LDmean)、平均管壁厚度(WTmean)及管壁面积占支气管断面总面积的百分比的平均值(WA%mean)并计算同级支气管各参数平均值,同时获得5个肺叶肺气肿指数(EI,EI=每个肺叶CT值低于-950 HU的容积/肺叶容积)。采用Spearman相关分析各级支气管定量参数与EI、肺功能的相关性。结果第4级支气管各定量参数与肺功能均无明显相关性(P>0.05),而第5、6级支气管的WA%mean与第1秒用力呼气量(FEV1)、第1秒用力呼气量的实测值与预测值的百分比(FEV1%)呈负相关(P<0.05),且相关系数随着支气管管径的变小而增加。在右肺上叶水平,第6级支气管WA%mean与右肺上叶EI呈正相关(r=0.66,P=0.02),左肺下叶水平第6级支气管LDmean与左肺下叶EI呈负相关(r=-0.66,P=0.01)。结论 MSCT定量成像能有效评价COPD小气道重塑及肺气肿,且肺气肿程度与小气道重塑有一定相关性。     

CT支气管定量分析技术在实变型肺挫伤合并急性呼吸窘迫综合征中的应用

目的 探讨CT支气管定量分析技术在实变型肺挫伤合并急性呼吸窘迫综合征（ARDS）中的临床应用价值。方法 回顾性分析34例实变型肺挫伤合并ARDS患者的资料,应用FACT-Digital Lung^TM软件分割CT图像,计算肺挫伤病灶体积占双肺容积的百分比,测量临床治疗前后肺挫伤病灶处2~4级支气管内腔横截面积、管壁横截面积、最大壁厚、平均壁厚、管腔最大密度、管腔平均密度、管腔内直径、管腔外直径、管腔内周长及管腔外周长。并进行统计学分析。结果 34例共56处肺挫伤病灶,治疗前肺挫伤病灶处2~4级支气管内腔横截面积、管壁横截面积、管腔内直径、管腔外直径、管腔内周长及管腔外周长均小于治疗后（P均<0.05）,最大壁厚及平均壁厚均大于治疗后（P均<0.05）,治疗前后管腔最大及平均密度差异均无统计学意义（P均>0.05）。肺挫伤病灶体积占双肺容积的百分比与胸部创伤严重程度评分呈正相关（r=0.71,P<0.01）。结论 CT支气管定量分析技术可直观显示实变型肺挫伤合并ARDS患者支气管形态学变化。     

冠状动脉异常起源合并升主动脉壁内走行的CT诊断

目的探讨冠状动脉异常起源合并升主动脉壁内走行的CTA特征及其诊断价值。方法回顾性分析14例冠状动脉异常起源并经外科手术证实为冠状动脉在升主动脉壁内走行(壁内走行组)的患者和50例冠状动脉起源异常无壁内走行(无壁内走行组)的患者资料,观察两组术前CTA图像特点,并与手术结果相对照。结果壁内走行组CTA正确诊断13例(13/14,92.86%)。CTA后处理的MIP血管轴位像显示冠状动脉横截面呈椭圆形,血管高度/宽度均>1.6,平均2.06±0.29;无壁内走行组异常走行血管的高度/宽度均<1.4,平均1.26±0.14,两组高度/宽度差异有统计学意义(t=8.547,P=0.005)。壁内走行组右冠状动脉发生率为64.29%(9/14);MIP血管轴位像见冠状动脉与升主动脉共用血管壁5例(5/14,35.71%)。结论血管横断面呈椭圆形是冠状动脉在升主动脉壁内走行的特征。CT可在术前识别壁内走行冠状动脉。     

64层螺旋CT冠状动脉成像对心肌桥-壁冠状动脉的评价

目的 探讨心肌桥-壁冠状动脉(MB-MCA)形态学特征及其与冠状动脉粥样硬化病变关系.方法 回顾性分析6729例可疑或确诊冠心病(CHD)患者64层螺旋CT冠状动脉血管成像(CTA)结果,由2位心血管CT诊断医师独立判断MB-MCA的存在,结果一致时诊断为MB-MCA.测量MB厚度、MCA长度及管径,记录MB-MCA位置、包绕情况、MCA两端成角情况,并记录MCA本身以及其近、远段冠状动脉粥样硬化病变情况,应用卡方检验,分析心肌桥近段、远段冠状动脉及壁冠状动脉自身动脉粥样硬化病变发生率有无差异.结果 6729例患者中发现MB-MCA总计1214例(18.0%),1262处.MB-MCA位于LAD者占90.7%(1145例).MSCT显示MCA可被心肌完全包绕(39.3%,496/1262)或不完全包绕(60.7%,766/1262).MCA长度为(18.6±9.0) mm.MB厚度为(2.2±1.7) mm.77.3%的MCA近端或(和)远端成角.MB-MCA近段和远段冠状动脉粥样硬化病变发生率分别为53.3%和2.3%,MCA本身粥样硬化病变发生率为0.5%,各组间有显著的统计学差异(P＜0.05).结论 64层螺旋CT能够清楚显示载MB-MCA冠状动脉全程和MB-MCA本身,并用于评价MB-MCA形态学特征.心肌桥近段冠状动脉易发生粥样硬化病变.     

超声心动图顺序分段诊断法与64排螺旋CT诊断肺动脉闭锁合并室间隔缺损

目的 探讨TTE顺序分段诊断法和64排螺旋CT术前诊断肺动脉闭锁(PA)伴室间隔缺损(VSD)的准确性。方法 对45例PA/VSD患儿于术前进行TTE和心脏MSCT检查, 以手术结果为金标准, 按心脏及大血管各解剖节段分别与手术所见对照, 分析比较二者诊断效能的差异性。结果 与手术结果对照, TTE和MSCT对腔静脉、肺静脉与心房连接、心室位置与房室连接、心室水平分流、心室与大动脉连接的诊断准确率均为100%;TTE与MSCT诊断肺动脉发育情况及动脉导管未闭的敏感度、特异度及准确率差异均无统计学意义(P均 >0.05);而在诊断心房水平分流方面、侧支血管及冠状动脉异常起源方面, 二者差异均有统计学意义(P均 <0.05)。结论 TTE顺序分段诊断法及MSCT均能较准确诊断PA/VSD。TTE在心内分流方面的诊断准确度优于MSCT;而在诊断主-肺动脉间侧支血管及冠状动脉起源方面, MSCT优于TTE。     

Computed tomographic angiography identification of intramural segments in anomalous coronary arteries with interarterial course

Certain coronary anomalies are associated with high risk features. We sought to determine the diagnostic accuracy of coronary computed tomographic angiography (CTA) in determining high-risk features, particularly intramural segments. Anomalous coronary arteries can be associated with adverse clinical events. Anomalous coronaries that course between the great vessels (interarterial) have been associated with sudden death. High-risk features of interarterial vessels described in the literature include; a slit-like orifice, acute angle of origin, and intramural segments (within the wall of the aorta). Although computed tomography (CT) findings of acute angle and slit like orifice have been described previously no prior evaluations regarding CT identification of an intramural segment have been reported. An intramural segment has distinct surgical management implications. All interarterial anomalous coronary arteries do not have an intramural segment. Since October 2004, 15 patients were diagnosed by CTA as having an anomalous coronary artery with an interarterial course, which were then confirmed by intraoperative examination of their coronary origins and course during aortic root/coronary artery surgery. The CTA images were retrospectively analyzed for the presence of high-risk features by a radiologist blinded to the surgical findings. Comparison of these findings was made to the findings at surgery. The anomalous coronary was the right coronary artery in 10 patients and the left coronary artery in 5. Eleven patients had an intramural segment identified at surgery. Pre-operative coronary CTA showed that all patients with an intramural course of the anomalous artery, had slit-like orifice, an acute angle of origin (mean 18.4 ± 3.4°), and an elliptical shaped cross-section throughout the intramural segment of the anomalous vessel. The average vessel height/width ratio for anomalous coronary vessels without an intramural segment was 1.03; compared to a ratio of 2.19 for anomalous vessels with an intramural segment (P = 0.003). Coronary CTA can identify an intramural segment of an anomalous interarterial coronary artery by its elliptical shape. Identifying an intramural segment has important clinical and surgical implications.     

双源CT诊断川崎病冠状动脉病变

目的 探讨双源CT(DSCT)诊断川崎病冠状动脉病变的临床应用价值。方法 对16例川崎病冠状动脉病变患者进行DSCT冠状动脉成像,将获得的数据进行容积再现(VR)、多平面重建(MPR)、最大密度投影(MIP)、曲面重建(CPR),观察冠状动脉病变的部位、数目、形态和大小,并和同期超声心动图(ECHO) 进行比较分析。结果 16例川崎病患者共累及22支血管,表现为单纯性冠状动脉扩张4例、单纯性冠状动脉狭窄2例、冠状动脉瘤10例(共28个),其中2例冠状动脉瘤伴钙化、4例冠状动脉瘤伴冠状动脉扩张。ECHO未显示的病变为小冠状动脉瘤4个(右冠状动脉远段2个、左前降支远段及左回旋支中段各1个)、冠状动脉钙化2例、冠状动脉狭窄1例、冠状动脉轻度扩张1例。结论 DSCT能清晰全面显示冠状动脉病变及程度,是川崎病冠状动脉病变患儿诊断和随访的重要评估方法。     

三维动态增强血流成像技术在胸部的应用价值

目的 研究3D DCE－MRA的扫描,探讨此项技术的临床应用价值。方法 32例患者,肺癌22例;肺动脉栓塞7例,肺段隔离症2例;肺动静脉畸形1例。除常规MR检查外,均行3D DCE－MRA检查,注射Gd-DTPA0.2ml/kg静注后,冠状位三维超快速梯度回波匙孔采集,4次动态,最大强度投影法（MIP）重建,分析图像对肺部血管的显示。结果 3D DCE－MRA可以清楚地显示不同时相的肺部血管,能显示肺癌与血管的关系,中心型肺动脉血栓的栓子,肺动脉隔离症的异常供血血管,对肺段以下的小血管显示价值有限。结论 3D DCE－MRA可清晰显示肺部段以上的肺动脉和肺静脉,对肺部血管性疾病的诊断及术前对肺癌手术计划的指导均有价值。     

Evaluation of bosentan,pinacidil and nitroprusside on human pulmonary arteries: comparison with rat pulmonary arteries*

Summary— Bosentan (endothelin ET_A/ET_B antagonist), pinacidil (potassium channel opener) and nitroprusside (nitric oxide donor) were examined on isolated ring preparations of human intralobar pulmonary artery (3rd-5th generation; internal radius > 1 mm), rat main pulmonary artery (1st generation; internal radius > 1 mm) and rat intralobar pulmonary artery (3rd generation; internal radius ≥ 0.1–0.3 mm). The potency of endothelin-1 was the same in all three artery types. In human intralobar artery and rat main pulmonary artery, bosentan (3 and 10 μM) shifted the endothelin-1 concentration response curve to a higher concentration range (endothelin-1 concentration ratios, in human intralobar and rat main pulmonary artery, respectively: 3 liM bosentan, 4.5 and 8.1; 10 /xM bosentan, 13.5 and 19.5), but caused no significant block of endothelin-1 in rat intralobar artery. The latter finding may be due to the reported presence of ET_B receptors in rat intralobar arteries and the higher potency of bosentan on ET_A than on ET_B receptors. In contrast, the potencies of nitroprusside and pinacidil (relaxation of submaximal contractions to the thromboxane-mimetic, U46619) agreed on human and rat intralobar arteries but were 6 to 16-fold lower than on rat main pulmonary artery. We conclude that data obtained on pulmonary arteries from rats can be useful in predicting the effects of vasoactive drugs in human pulmonary arteries but selection of the most appropriate rat artery for study will depend on the drug group under investigation. For potassium channel openers and nitric oxide donors, good agreement between human and rat data will be found when using pulmonary arteries from the same anatomical location even though they differ markedly in size. In contrast, for endothelin antagonists, agreement is more likely to be found in arteries of comparable size, despite their different anatomical locations.     

肺灌注断层显像评价肺动脉血栓内膜剥脱术对慢性血栓栓塞性肺动脉高压的疗效

目的 采用⁹⁹Tc^m-人体大颗粒聚合白蛋白（⁹⁹Tc^m-MAA）肺灌注断层显像评价肺动脉血栓内膜剥脱术（PTE）对慢性血栓栓塞性肺动脉高压（CTEPH）的疗效。方法 对16例CTEPH患者分别于术前、术后6~12个月行肺灌注断层显像,观察术前、术后肺叶、肺段灌注病变及改善情况,计算全肺灌注缺损百分比（PPDs%）,并采用超声心动图观察术前、术后肺动脉收缩压（SPAP）的变化。结果 16例患者术后SPAP[（36.56±8.47） mmHg]较术前[（90.52±14.55） mmHg]明显减低（t=14.14,P<0.001）。PTE术前16例患者的96个肺叶中有86个（86/96,89.58%）存在灌注异常,术后完全改善、部分改善的肺叶分别为21个（21/86,24.42%）、65个（65/86,75.58%）;术前16例患者的304个肺段中,230个（230/304,75.66%）肺段灌注异常,术后完全改善、部分改善和未改善的肺段分别为73个（73/230,31.74%）、74个（74/230,32.17%）和83个（83/230,36.09%）。术前PPDs%为（56.79±14.54）%,术后6~12个月降低为（28.20±15.24）%（t=8.13,P<0.001）。PPDs%与同期SPAP呈正相关（r=0.68,P<0.001）。结论 PTE可使CTEPH患者的SPAP明显降低,肺血流灌注明显改善,肺灌注显像可有效评价PTE疗效。     

正常成人上肢动脉彩色多普勒超声测量

目的　应用彩色多普勒超声检查和测量正常上肢动脉 ,以得出上肢动脉的超声正常值。方法　15 3名健康志愿者 3 0 6条上肢动脉 ,每条上肢分 7个节段。测量解剖学和血流动力学参数。结果　获得上肢动脉各节段各参数超声正常值 ,发现上肢动脉从近心至远心段 ,内径减少 ,管壁变薄 ,收缩期峰值流速、收缩期加速度、搏动指数值下降 (P <0 .0 5 ) ;上肢动脉各节段均可表现多种流速曲线形态 ,近心段以双向三峰所占比例大(67%锁骨下动脉段双向三峰 ) ,腋动脉以远段反向峰渐不明显 (4 5 .2 %肱动脉段单向双峰 )。结论　彩色多普勒超声能成功用于检查上肢动脉 ,发现变异和病变。