肺动脉栓塞诊断的比较影像学

目的评价X线胸片、超声心动图、核素肺灌注扫描、电子束CT（EBCT）、MR肺动脉造影（MRPA）、肺动脉造影（PAG）在肺动脉栓塞（VIE）诊断中的应用价值。方法自2003年7月至2004年3月间临床确诊的PTE患者25例。常规行胸部正侧位摄片、超声心动图、EBCT肺动脉造影、核素肺灌注扫描、MRPA及PAG。PAG由2名有经验医师共同分析每一支肺动脉及其叶段分支，诊断意见作为标准并与其他方法进行对照。结果PAG技术成功率100％，775个受检肺动脉分支中共检出556个分支受累（71．7％）。25例患者中X线胸片提示诊断12例。超声心动图诊断9例，右房室增大21例，肺动脉高压18例。核素肺灌注显像结果显示500个肺段中有247个肺段受累（52．0％），与PAG对照对段的敏感度为64．66％。EBCT肺动脉造影（EBCTPA）的分析显示775个肺肺动脉分支中共有523个主干及叶段分支受累，段以上分支敏感度为94．06％；10例行MRPA的患者中8例检查成功，248各肺动脉分类中共155个分支受累（62．5％），段以上敏感度为81．29％。结论EBCT对PTE的诊断具有较高的敏感度，X线胸片和超声心动图为必不可少的检查手段，EBCT可作为一线影像学诊断方法，核素肺灌注扫描及MRPA可作为二线诊断方法。     

增强螺旋CT和肺动脉造影在肺动脉栓塞诊断和治疗中的应用

目的 评价螺旋CT和肺动脉造影在肺动脉栓塞诊断和治疗中的作用。方法 回顾性分析经螺旋CT增强和肺动脉造影明确诊断的18例患者的影像资料。其中12例经肺动脉造影后，行导管抽吸和局部溶栓治疗。结果 18例患者累及107处肺动脉及其分支，双肺下叶主支受累最多，达28．97％，累及左、右肺动脉主干者占22．43％，累及肺叶以下分支达40．18％，累及主肺动脉者占8．41％。肺动脉栓塞的影像学直接征象包括部分性充盈缺损、附壁性充盈缺损、中心性充盈缺损（即“轨道征”）、完全阻塞，间接征象包括主肺动脉增宽、局限性肺纹理稀疏、肺梗死和胸腔积液。12例术后临床症状改善，动脉血氧分压增高。结论 螺旋CT增强扫描是一种有效的诊断肺动脉栓塞的无创性检查手段，且诊断率较高。     

螺旋CT肺动脉造影对于肺动脉栓塞的诊断价值(附8例报告)

目的评价螺旋CT肺动脉造影对于肺动脉栓塞的诊断及随访观察溶栓疗效的可靠性和准确性。方法经我院螺旋CT肺动脉造影诊断的8例肺动脉栓塞患者中有5例进行溶栓治疗。结果8例患者共有17处肺动脉及分支受累。动脉栓子呈偏于管腔一侧的突起状、不规则状和位于管腔中心的柱状及完全堵塞状态。5例溶栓治疗后有3例栓子完全消失，2例栓子明显缩小。结论螺旋CT肺动脉造影在诊断肺动脉栓塞和治疗随访观察疗效过程中都有着重要的价值，可望成为肺动脉栓塞诊断的首选方法。     

多层螺旋CT在肺动脉栓塞诊断中的应用价值

目的 研究多层螺旋CT在肺动脉栓塞诊断中的临床应用，着重研究亚段肺动脉栓塞的诊断价值。方法 共34例，下肢深静脉血栓16例，近期大手术史11例，肺癌1例，不明原因6例。34例均使用GE Light Speed Plus多层螺旋CT(MSCT)行平扫及造影增强扫描，1次采集4层图像。结果 分析34例共1824支肺动脉分支，其中507支肺动脉分支显示了栓塞，占27．8％。在680支肺段动脉中，246支显示了栓塞，占36．2％；而亚段肺动脉1041支中，141支显示了栓塞，占13．5％。平扫肺动脉栓塞的间接征象为肺纹理稀少19例，肺动脉高压2例，胸水16例，胸膜下梗死灶共41个，梗死灶多发11例，单发12例，双肺6例。1例慢性栓塞栓子钙化，极为少见。造影增强后肺动脉栓塞的直接征象为不同程度的肺动脉分支充盈缺损。充盈缺损有4种表现形式：中心型57支，偏心型160支，附壁血栓131支，完全阻塞型159支。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，可与电子束CT媲美，可能成为诊断肺动脉栓塞的首选方法。     

螺旋CT肺动脉造影的临床应用

目的：探讨螺旋CT肺动脉造影（SCTPA）的方法及临床价值。方法：对25例肺部疾病患者进行了SCTPA，包括中央肺癌16例，周围型肺部7例，肺动静脉瘘2例。技术参数为：扫描层厚2．7mm，重建层厚1．5mm，螺距1－1．5。其中11例在从右上肢注入对比剂，14例从右下肢注入对比剂，重建方法包括MPR、SSD及MIP。结果：25例中24例SCTPA成功。5例中央肺癌SCTPA显示主肺动脉与两下肺动脉干或心包内段肺静脉与左心房受侵犯而取消手术，另10例中央型肺癌SCTPA与手术病理所见基本一致，仅6支正常血管分支误认为肿瘤侵犯，号肿块紧贴血管分支有关。7例周围型肿癌SCTPA显示了肿块与血管的关系。2例肺动脉瘘中1例左下肺动脉静脉瘘与插管法肺动脉造影所见完全一致（另一例未做插管法肺动脉造影）。在SCTPA方法上，本文14例采用从右下注入对比剂者消除了上腔静脉（SVC）放射状伪影的干扰，显著提高了图像质量。结论：SCTPA对肺血管性疾病及肺癌对血管的侵犯与肺癌可切除性的评估有较高的临床实用价值。改用从右下注入对比剂行SCTPA可消除SVC放射状伪影，显著改善图像质量。     

以冠状动脉-肺动脉瘘为肺循环主要供血来源的肺动脉闭锁合并室间隔缺损的心血管造影分析

目的　探讨心血管造影对以冠状动脉-肺动脉瘘为肺循环主要供血来源的肺动脉闭锁合并室间隔缺损的诊断价值。方法　回顾性分析2例肺动脉闭锁合并室间隔缺损及冠状动脉-肺动脉瘘的X线平片、超声心动图及心血管造影表现。结果　本组2例,男女各1例,年龄分别为4岁和8个月。临床表现为发绀,心前区杂音,心电图均为右室肥厚,但临床及心电图均无心肌缺血证据。心导管检查肺动脉血氧比右室显著增高,1例有轻度肺动脉高压。心血管造影示受累冠状动脉增粗,发出分支向肺动脉供血,并且该分支为肺动脉惟一血供来源。1例累及左冠状动脉,另1例为右冠状动脉。2例均经心血管造影诊断并为外科手术证实,分别行择期根治术及分流术成功。结论　以冠状动脉肺动脉瘘为肺循环主要供血来源的肺动脉闭锁合并室间隔缺损是一罕见畸形,术前确诊的“金标准”仍是心血管造影     

螺旋CT肺动脉造影对肺栓塞的诊断

目的：评价螺旋CT及其肺动脉造影诊断肺动脉栓塞（PE）的价值。方法：回顾性分析12例PE患,均行螺旋CT容积扫描,并在工作站进行图像后处理,获得肺动脉多平面重建图像及三维立体图像。结果：对12例196支肺动脉分支进行分析,受累率为46.4%;栓子发生在主肺动脉、左右肺动脉干及叶段肺动脉。多平面重建图像上表现为充盈对比剂血管内有充盈缺损区,或其远侧方无对比剂充填区。肺动脉成像示,主干血管内可见充盈缺损影,或呈截断状影;叶栓塞或段栓塞亦呈突然“截断状”,其远侧方肺动脉分支不显影或呈纤维状。结论：螺旋CT肺动脉造影不仅可以获得轴位图像,而且可以获得立体图像,可多轴向旋转观察PE部位,是诊断叶或段以上PE可靠而直观的检查方法。     

右心室流出道梗阻性病变病人肺动脉的比较评价

作者研究了20例重度紫绀型先天性心脏病儿童(平均8.4岁)CT,超声和电影血管造影评价中心肺动脉的作用。CT显示了6例电影血管造影不能辨认的肺动脉(右_4左_2)。1/3的右肺动脉内狭窄用CT和超声检查比电影血管造影更清楚。相反4例电影血管造影发现的左肺动脉起始处狭窄,CT和超声均未发现。5例肺动脉不汇合3种检查方法均能辨认出。肺动脉直径的测量,3种技术的结果有很大不同,因为各自采用的检查平面不同所造成。CT和超声测量左肺动脉有过度估计的倾向。CT、超声无法测量肺动脉分支内的周围性狭窄及左肺动脉起始处的狭窄。虽然电影血管造影被认为是估价肺动脉大小和分布的最好方法,但对心包内肺动脉的显示亦可失败。它检测中心肺动脉失败的原因为流动现象造成造影剂减少而不显影或肺动脉内血栓形成。CT对电影血管造影和超声具有辅助     

64层螺旋CT肺动脉造影在肺动脉栓塞诊断中的应用

目的 探讨64层螺旋CT肺动脉造影(CT pulmonary angiography,CTPA)对肺动脉栓塞(pulmonary embolism,PE)的诊断价值.方法 回顾分析24例肺动脉栓塞患者的64层螺旋CT增强图像,将原始图像复制到EBW4.0工作站,对肺动脉主干及分支进行多平面重建(MPR),最大密度投影(MIP)及容积重建(VR)分析.结果 24例患者中,共检出了76处肺动脉及其分支的栓子.其中,左、右肺动脉主干14处(右主干10处、左主干4处),肺叶动脉24处,肺段动脉26处,亚肺段动脉12处.CT表现为肺动脉主干或分支内混合性、附壁性、中心性充盈缺损,可分为完全性或部分性.结论 64层CTPA具有准确、高效、无创等优点,可直观、立体地观察到肺动脉血栓的大小、分布、范围及类型,是临床诊断及观察疗效的首选方法,有望成为肺动脉栓塞检查的“金标准”.     

肺动脉吊带的影像学诊断

目的 评价肺动脉吊带的影像学诊断价值。方法 7例肺动脉吊带中5例做了心血管造影（ACG）（5例均做了MR检查，4例同时做了CT检查），2例仅做MR检查。结果 7例肺动脉吊带病例中6例显示左肺动脉起始于右肺动脉远端分叉部，并绕过气管后方（4例有气管压迫征象，临床有气急、喘鸣的症状），另有1例为左下肺动脉起始于右肺动脉远端近分叉处，左上肺动脉起始正常。5例经手术证实。结论 ACG、造影增强磁共振血管造影（CE-MRA）、CT血管造影（CTA）为明确肺动脉吊带诊断的最佳方法，3种方法可互为补充。心血管造影选择性强，CE-MRA的三维成像显示肺动脉的走向较有优势；CTA可以同时显示气管和异常起源的左肺动脉之间的关系。     

肺动脉异常起源于升主动脉的影像学诊断

目的 探讨肺动脉异常起源于升主动脉的影像学诊断价值。资料与方法 6例肺动脉异常起源于升主动脉，作心血管造影(ACG)及MRI检查。结果 6例中3例为右肺动脉异常起源于升主动脉，均为近端型；3例为左肺动脉异常起源于升主动脉，1例属近端型，2例远端型。结论 肺动脉异常起源于升主动脉为少见的先天性心脏病，心血管造影仍是诊断的主要手段，MRI是非创伤性检查中较为可靠、有潜力的诊断方法。     

产前超声心动图诊断胎儿单侧肺动脉异常起源于升主动脉的应用价值

目的探讨三血管气管-肺动脉分叉切面在诊断单侧肺动脉异常起源于升主动脉(AOPA)中的应用价值。方法选取我院确诊的5例AOPA,总结AOPA在该切面声像图特点,结合随访病理解剖和其他影像学复查情况与产前超声诊断进行对比分析。结果在5例患儿中左肺动脉异常起源主动脉弓(AOLPA)4例,右肺动脉异位起源主动脉弓(AORPA)1例,同时合并其他心内畸形者2例,远端型4例,近端型1例。结论超声检查是诊断胎儿单侧肺动脉异常起源主动脉弓的重要方法,三血管气管-肺动脉分叉切面有其特殊的声像图表现,能提高对本病的认识降低误、漏诊率。     

高压氧疗对高海拔地区大鼠肺动脉压及血清血管紧张素转换酶的影响

本实验利用移居高原的Ｗｉｓｔａｒ大鼠在采用常规高压氧治疗一疗程后，用入导生理记录仪浊体、动脉压、取血浊血清血管紧张素转换酶活性，发现治疗后肺动脉平均后有非常显著下降（Ｐ〈０．０１）；血清轿管紧张素转换酶活性显著增强（Ｐ〈０．０５）；提示高原地区运用高太氧疗对肺动脉高压有一定治疗作用；从血清血管紧张素转换酶活性变化中未有证实高夺氧对肺组织的损伤。     

Flow characteristics of the proximal pulmonary arteries and vena cava in patients with chronic thromboembolic pulmonary hypertension: correlation between 3.0 T phase-contrast MRI and right heart catheterization

PURPOSE

We aimed to determine the correlation between flow characteristics of the proximal pulmonary arteries and vena cava obtained by 3.0 T phase-contrast magnetic resonance imaging (MRI) and hemodynamic characteristics by right heart catheterization in patients with chronic thromboembolic pulmonary hypertension.

MATERIALS AND METHODS

Twenty consecutive patients with chronic thromboembolic pulmonary hypertension and 20 sex- and age-matched healthy volunteers were included prospectively. All patients and controls underwent phase-contrast MRI to determine the flow characteristics including peak velocity, mean velocity, and mean blood flow of the proximal pulmonary artery and vena cava. All patients underwent right heart catheterization to determine the hemodynamics.

RESULTS

Peak velocity and mean velocity of the proximal pulmonary artery were significantly lower in the patient group. In patients, both peak velocity and mean blood flow were sequentially decreased in the main pulmonary artery, left and right pulmonary arteries, and left and right interlobar pulmonary arteries. Inferior vena cava had higher peak velocity, mean velocity, and mean blood flow than superior vena cava. Peak velocity of the main pulmonary artery correlated with mean and diastolic pulmonary artery pressure. Peak velocity of both inferior and superior vena cava strongly correlated with the pulmonary vascular resistance index (PVRI) (r=−0.68, P < 0.001 and r=−0.74, P < 0.001, respectively). Mean velocity of the main pulmonary artery and right pulmonary artery strongly correlated with PVRI and mean pulmonary artery pressure. Mean velocity of the superior vena cava and mean blood flow of the main pulmonary artery strongly correlated with PVRI and right cardiac work index.

CONCLUSION

Blood flow in the proximal pulmonary artery and vena cava evaluated by phase-contrast MRI correlate with hemodynamic parameters of right heart catheterization and can be used to noninvasively evaluate the severity of chronic thromboembolic pulmonary hypertension and, potentially, to follow up the treatment response.Chronic thromboembolic pulmonary hypertension (CTEPH) develops as a result of obstruction of pulmonary arterial vessels by organized thromboembolic material and subsequent vascular remodeling in small unobstructed vessels, and it is associated with significant morbidity and mortality (1). Right heart catheterization remains the reference standard to diagnose CTEPH, assess the hemodynamic disturbance, and follow up the treatment response; but it is invasive, delivers radiation, and is associated with recognized complications (2, 3).Magnetic resonance imaging (MRI) is considered not only as the reference standard for evaluation of ventricular function, but it also provides a reproducible and noninvasive assessment of hemodynamics changes in pulmonary hypertension (4). In a separate validation study, cardiac MRI-derived parameters showed a strong correlation with invasive determinations (5).In a study by Mohiaddin et al. (6), phase-contrast MRI was used to confirm reduced diastolic peak velocity of the inferior vena cava (IVC) in patients with pulmonary hypertension. Only one study reported blood flow conditions in the proximal pulmonary arteries and vena cava in healthy children (7). To our knowledge, no study has assessed proximal pulmonary artery and vena cava flow or evaluated correlation of the flow determined by phase-contrast MRI and hemodynamics by right heart catheterization in CTEPH.We performed a prospective study to observe the flow change in the proximal pulmonary artery, superior vena cava (SVC) and inferior vena cava (IVC) in patients with CTEPH by phase-contrast MRI, and to evaluate the correlation of the proximal pulmonary artery and vena cava flow with hemodynamics derived by right heart catheterization in patients with CTEPH.     

In vivo MR imaging of pulmonary arteries of normal and experimental emboli in small animals

PURPOSE: To demonstrate the feasibility of pulmonary MRA in living rodents. MATERIALS AND METHODS: A three-dimensional (3D) gradient echo sequence was adapted to perform a time-of-flight (TOF) angiography of rat lung. Angiogram with a spatial resolution of 195 x 228 x 228 microm(3) was acquired in around 33 minutes. The method was then applied in animals before and after pulmonary embolism (PE) induction. Section of the proximal right pulmonary artery was measured and compared between the two populations. RESULTS: Good quality images were obtained with a contrast-to-noise ratio (CNR) of 9 +/- 3 in the proximal part of the pulmonary artery. Cross-section areas of the right main artery are statistically different before (3.45 +/- 0.69 mm(2)) and after induction of PE (4.3 +/- 0.86 mm(2)). CONCLUSION: This noninvasive tool permits angiogram acquisition at around 200 microm spatial resolution and objective distinction between healthy and embolized arteries.     

Computed tomography in pulmonary artery sarcoma: distinguishing features from pulmonary embolic disease

OBJECTIVE: The purpose of this study was to present the computed tomography (CT) findings of pulmonary artery sarcoma in 7 patients with a focus on the distinguishing features of pulmonary embolic disease. METHODS: For the 9 years from December 1993 to November 2002, we treated 7 patients with pathologically proven pulmonary artery sarcoma, and during the 2 years from December 2000 to November 2002, we treated 40 patients with acute (n = 33) or chronic (n = 7) pulmonary embolism. In these patients, pulmonary embolism was diagnosed from serial CT or clinical findings. Two chest radiologists, blinded to the diagnoses, independently reviewed the scans of all 47 patients in random order, and the so-documented CT features of sarcoma and pulmonary embolism were compared by using Fisher exact test or the generalized estimating equations test. RESULTS: The two most frequent CT findings of pulmonary artery sarcomas were a low-attenuation filling defect occupying the entire luminal diameter of the main (n = 1) or proximal (n = 6) pulmonary artery and an expansion of any segment of the pulmonary artery with extensive intraluminal filling defect, as observed in six (86%) of 7 patients. In contrast, the finding of a lesion occupying the entire luminal diameter at the level of proximal pulmonary arteries was absent in all 40 patients with pulmonary embolism (P < 0.0001) (kappa = 0.9111). Expansion of the pulmonary arteries was seen in one (3%) of 40 patients with pulmonary embolism (P < 0.0001) (kappa = 0.9108). Extraluminal extension was observed in 5 of 7 (71%) patients with sarcoma, but in no patient with an embolism (P < 0.0001) (kappa = 0.8773). CONCLUSION: CT can help differentiate pulmonary artery sarcoma from pulmonary embolism by indicating a low-attenuation filling defect occupying the entire luminal diameter of the proximal or main pulmonary artery, expansion of the involved arteries, or extraluminal tumor extension.     

常氧与缺氧状态下脑啡肽和吗啡对兔肺动脉平滑肌增殖的调控作用

探讨常氧与缺氧状态下脑啡肽对兔肺动脉平滑肌增殖的调控作用及机制,为解决经皮腔内冠脉成形术支架后冠脉再狭窄问题提供新的理论依据。无菌取出新西兰白兔动脉段,在常氧和缺氧条件下胺照Ｒｏｓｓ贴片培养平滑肌,和相差显微镜,透射电镜和（－肌动蛋白体鉴定平滑肌细胞,四唑盐比色法及３－ＨｄＲ参人实验检测平滑肌的生长状况。     

Value of pulmonary vein wedge angiography in visualization of obstructed ipsilateral pulmonary artery

Left ventricular cineangiogram in a 2-year-old child with a large ventricular septal defect, pulmonary atresia and a previous Waterston anastomosis opacified clearly the right pulmonary artery but the left pulmonary artery could not be visualized. The later was thought to be due to obstruction or kinking of the right pulmonary artery proximal to the Waterston anastomotic site. A left pulmonary vein wedge angiogram performed via a No. 5 end-hole catheter with 4.0 cc of meglumine diatrizoate (75% Hypaque) injected under pressure (less than 100 PSI) visualized the left pulmonary artery in a retrograde fashion. The size of the left pulmonary artery at this study was comparable to its size measured at the time of a subsequent left Blalock-Taussig anastomosis. Pulmonary vein wedge angiography with 0.3 cc/kg body weight of contrast material injected over a two second period (less than 100 PSI) appears to be a useful technique in demonstrating the pulmonary arteries when these cannot be visualized by conventional antegrade techniques.