急性肺栓塞所致右心功能不全的CTPA诊断价值

目的 探讨CT肺血管造影(CTPA)对急性肺栓塞(PE)所引起的右心功能不全(RVD)的诊断价值.方法 回顾性分析经CTPA确诊的、并于24 h内行超声心动图(UCG)检查的急性肺栓塞患者36例,并按病情严重性分为大面积肺栓塞组(24例)和非大面积肺栓塞组(12例).本研究以UCG的结果作为RVD的诊断标准,将CTPA的结果与UCG的结果相对照.CTPA诊断RVD的标准为在横切位CT图像上显示右心室增大(RVd/LVd>1)或室间隔异常移位.结果 36例肺栓塞患者中,UCG共诊断RVD阳性13例,阴性23例.CTPA诊断RVD阳性16例,阴性20例.以UCG为标准,CTPA的诊断敏感性为84.61%、特异性为78.26%、阳性似然比为3.892、阴性似然比为0.197、阳性预测值为68.75%、阴性预测值为90%,Kappa值为0.60,诊断具有中等一致性.24例大面积肺栓塞患者中,UCG诊断RVD阳性13例,阴性11例.CTPA诊断RVD阳性14例,阴性10例.以UCG为标准,CTPA的诊断敏感性为84.61%、特异性为72.73%、阳性似然比为3.103、阴性似然比为0.212、阳性预测值为78.57%、阴性预测值为80%,Kappa值为0.58,诊断具有中等一致性.12例非大面积肺栓塞患者中,UCG诊断均为RVD阴性.CTPA诊断RVD阳性2例,阴性10例,诊断特异性为83.33%.统计学分析发现,2组之间的RVd/LVd值有显著性差异,CTPA与UCG结果在大面积肺栓塞组有较好的相关性,而在非大面积肺栓塞组无明显相关性.结论 CTPA不仅可以对肺栓塞做出直接诊断,而且通过分析心脏的形态学改变,可以较为准确地判定肺栓塞患者是否伴发右心功能不全.     

MSCTPA对肺栓塞患者右心功能的诊断价值

目的以超声心动图作为诊断右心功能的标准,探讨64层CT肺血管造影(CTPA)对肺栓塞患者右心功能的诊断价值。方法前瞻性收集了临床疑诊肺栓塞的41例行CTPA检查的患者,阳性组根据右心功能、肺动脉栓塞部位及肺动脉压力指数分组,薄层数据进行最大密度投影(MIP)、多平面重建(MPR)和容积再现(VRT),分析各组数据中右心功能参数的差异。结果 41例患者中肺栓塞阳性24例,阴性17例,CTPA诊断右心功能不全13例,超声心动图诊断右心功能不全11例。以超声心动图为标准,64层CTPA诊断右心功能不全的灵敏度为76.9%,特异度为90.9%,阳性预测值90.9%,阴性预测值76.9%,Kappa值为0.669,诊断具有中度一致性。对于主肺动脉干(PA)、升主动脉(Aorta)、上腔静脉(SVC)、奇静脉(AV)、冠状静脉窦(CS)、PA/Aorta比、LVd、RVd及RVd/LVd比之间比较,第一组中差异有统计学意义的指标有PA、PA/Aorta比,LVd、RVd及RVd/LVd,CS;第二组中差异均无统计学意义;第三组中,差异有统计学意义的指标有PA/Aorta比。结论 MSCTPA及其后处理重建技术可以在诊断肺栓塞的同时对心功能作出评价。     

CT阻塞指数对肺栓塞的评价及其与D-二聚体相关性分析

目的：探讨肺动脉CT阻塞指数对肺栓塞(PE)高危性的评价及其与D-二聚体之间的关系。方法收集经 CT肺动脉成像(CTPA)及D-二聚体检查的125例PE病例。将其分为高危PE组和非高危PE组,比较分析2组在 CT阻塞指数、D-二聚体、主肺动脉直径间的差异,以及肺动脉 CT 阻塞指数与 D-二聚体、主肺动脉直径之间的相关性(Spearman相关性评价)。结果高危PE组的CT阻塞指数明显高于非高危PE组(P=0.000),高危PE组主肺动脉直径较非高危PE组增粗,差异有统计学意义(P=0.000),而高危PE组和非高危PE组D-二聚体差异无统计学意义(P=0.103)。CT阻塞指数与D-二聚体无相关性(P=0.71)。结论血浆D-二聚体指标可以提示PE,不能评价PE的高危性;肺动脉CT阻塞指数在一定程度上可以反映PE的严重性,其与 D-二聚体间无相关性。     

彩色多普勒超声联合D-二聚体对周围型下肢深静脉血栓筛查的价值

目的探讨彩色多普勒超声(CDUL)联合D-二聚体检测对周围型下肢深静脉血栓的筛查价值。方法对1821例下肢深静脉血栓的高危患者行下肢深静脉CDUL检查及D-二聚体的检测。分别计算CDUL、血浆D-二聚体浓度水平检测以及二者联合对高危人群中周围型下肢深静脉血栓形成的灵敏度、特异度、阳性预测值、阴性预测值以及Kappa值。结果CDUL诊断周围型下肢深静脉血栓形成的灵敏度、特异度、阳性预测值、阴性预测值、Kappa值为95.8%、94.5%、88.2%、98.1%、0.881。血浆D-二聚体浓度检测诊断周围型下肢深静脉血栓形成的灵敏度、特异度、阳性预测值、阴性预测值、Kappa值为85.2%、95.6%、89.3%、93.8%、0.818。二者联合诊断周围型下肢深静脉血栓形成的灵敏度、特异度、阳性预测值、阴性预测值、Kappa值为98.0%、100.0%、100.0%、99.1%、0.986。CDUL联合D-二聚体检测与单独行D-二聚体检测及CDUL检查的差异均有统计学意义(均P<0.05)。结论CDUL检查联合血清D-二聚体检测对筛查周围型下肢深静脉血栓有较高的诊断准确率,具有较高的临床价值。     

宝石CT能谱成像技术在肺栓塞诊断中的价值

目的探讨宝石CT能谱成像技术在肺栓塞诊断中的价值。方法对22例肺栓塞患者行宝石CT能谱增强扫描,通过数据处理同时获得CT肺动脉造影(CTPA)及肺组织碘基图。在CTPA图上观察肺动脉内有无栓子,并记录栓子发生的部位及数量;定量测定肺组织碘基图中碘含量正常区与异常区的碘含量值,并记录碘含量异常区的部位及数量,通过配对t检验观察两组结果间的差异;以CTPA诊断结果为参照,肺组织碘基图与CTPA的诊断一致性采用Kappa检验,同时计算出肺组织碘基图诊断肺栓塞的敏感性、特异性、阳性预测值及阴性预测值。结果22例患者CTPA共诊断124处肺栓塞,其中左右肺动脉6处,肺叶动脉24处,肺段动脉68处,肺亚段动脉26处。肺组织碘基图共检出113处肺组织碘含量降低,碘含量异常区均值0.12±2.11(100μg/cm3),碘含量正常区均值18.56±6.37(100μg/cm3),二者的差异有统计学意义(t=22.43,P<0.05)。以CTPA为参照,肺碘基图诊断了左右肺动脉水平6处,肺叶动脉水平23处,肺段动脉水平59处,肺亚段动脉水平21处肺栓塞;另有4处肺碘基图异常而CTPA诊断为阴性。肺碘基图与CTPA对肺栓塞的诊断经一致性Kappa检验(K=0.913,P<0.001),二者具有良好的一致性。肺碘基图诊断左右肺动脉栓塞的敏感性、特异性、阳性预测值及阴性预测值均为100%;诊断肺叶动脉栓塞的敏感性为95.83%,特异性为100%,阳性预测值为100%,阴性预测值为98.85%;诊断肺段动脉栓塞的敏感性为86.76%,特异性为99.19%,阳性预测值为95.16%,阴性预测值为97.62%;诊断肺亚段动脉栓塞的敏感性为80.77%,特异性为99.88%,阳性预测值为95.45%,阴性预测值为99.42%。结论宝石CT能谱肺碘基图反映了肺组织血流灌注情况,能够显示肺栓塞时肺血管功能的改变,对肺栓塞的早期诊断、病情评估及疗效评价提供重要依据,具有重要的临床应用价值     

彩色多普勒超声与D-二聚体在下肢闭合性骨折术后并发深静脉血栓诊断中的相关性

目的:探讨D-二聚体与彩色多普勒超声在下肢闭合性骨折术后并发深静脉血栓(DVT)诊断中的相关性。方法 :对99例彩色超声检查阳性患者的D-二聚体数据进行统计分析,观察D-二聚体结果判断DVT是否有节点阈值及其与彩色超声检查结果的相关性。结果:将D-二聚体结果分为5组,分别为0.5~3、3~5、5~7、7~9和9 mg/L组。组内比较D-二聚体在0.5~3 mg/L所占比例最高,发生下肢DVT可能性高;组间比较D-二聚体在5~9 mg/L时比例较对照组高,发生DVT可能性高。ETA相关性检测,ETA2=0.005 3说明D-二聚体检测结果与彩色超声结果基本不相关。结论 :彩色多普勒检查仍是诊断DVT的必要手段,D-二聚体值与DVT的形成之间无必然关系,但D-二聚体检测值有一定的参考范围,可为骨折术后早期发现DVT提供一定的依据。     

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.     

肺通气血流灌注显像、螺旋CT肺动脉造影及D-二聚体测定对诊断肺栓塞的临床价值

目的探讨放射性核素肺通气血流灌注比值(V/Q)显像和螺旋CT肺动脉造影(SCTPA)以及血浆D-二聚体(dimer)检测对肺栓塞(PE)诊断的临床价值。方法对我院2010年2月—2013年2月可疑肺栓塞的患者,行V/Q显像、SCTPA检查和血浆D-二聚体测定以及相关检查,以最终临床诊断为依据,分别评价V/Q显像、SCTPA和血浆D-二聚体测定对PE的诊断价值。结果 278例高度怀疑PE患者经上述检查确诊PE患者151例,V/Q显像、SCTPA检查和血浆D-二聚体测定诊断PE的灵敏度、特异性、阳性预测值、阴性预测值分别为93.6%(132/141)、96.0%(120/125)、96.4%(132/137)、93.0%(120/129);95.8%(137/143)、96.9%(124/128)、97.2%(137/141)、95.4%(124/130);99.3%(140/141)、43.1%(59/137)、64.2%(140/218)、98.3%(59/60)。结论血浆D-二聚体测定的价值主要用于排除PE。对PE患者的检查应力求全面,V/Q显像、SCTPA检查均有其优点和不足,只有全面掌握各项检查的特点,才能对该项检查对疾病的诊断价值做出正确评价,从而正确运用这一诊断方法更好地服务于临床。     

能谱成像在肺栓塞诊断中的临床应用

目的探讨宝石CT能谱成像碘基图及最佳单能量成像在肺栓塞诊断中的价值。方法对28例肺栓塞患者行宝石CT能谱增强扫描,以70Kev单能量图为标准对照最佳单能量图像CTPA观察肺动脉内有无栓子,并记录栓子发生的部位及数量;定量测定肺组织碘基图中碘含量正常区与异常区的碘含量值并记录碘含量异常区的部位及数量,通过配对t检验分别观察两组结果间的差异;与70Kev CTPA单能量图的诊断一致性采用Kappa检验,同时计算出最佳单能量成像、肺组织碘基图诊断肺栓塞的敏感性、特异性、阳性预测值及阴性预测值。结果 28例患者利用70KevCTPA图像共发现肺栓塞108处,CTPA最佳单能量图共显示128处肺栓塞,肺组织碘基图共检出133处,碘含量异常区均值(0. 12±2. 11) 100μg/cm~3,碘含量正常区均值(18. 56±6. 37) 100μg/cm~3,二者的差异有统计学意义(t=21. 26,P 0. 05)。最佳单能量成像、肺碘基图与70Kev CTPA对肺栓塞的诊断经一致性Kappa检验K值分别为(K=0. 924、K=0. 935,P 0. 001),二者联合对照70Kev CTPA图像诊断肺栓塞具有良好的一致性。肺碘基图联合最佳单能量图诊断肺动脉主干栓塞的敏感性、特异性、阳性预测值及阴性预测值均为100%;诊断肺叶动脉栓塞的敏感性为95. 83%,特异性为100%,阳性预测值为100%,阴性预测值为99. 85%;诊断肺段动脉栓塞的敏感性为86. 76%,特异性为99. 19%,阳性预测值为95. 16%,阴性预测值为97. 62%;诊断肺亚段动脉栓塞的敏感性为80. 77%,特异性为99. 88%,阳性预测值为95. 45%,阴性预测值为99. 42%。结论宝石CT最佳单能量图像可以提高肺段以下动脉栓塞的显示率,能谱肺碘基图反映了肺组织血流灌注情况,能够显示肺栓塞时肺血管功能的改变,二者结合对肺栓塞的早期诊断、病情评估及疗效评价提供重要依据,具有重要的临床应用价值。     

D-二聚体测定联合临床评分对急性肺栓塞的诊断价值

目的评价D-二聚体测定联合临床评分对急性肺栓塞的诊断价值。方法以经过CT肺动脉造影确诊的急性肺栓塞（APE）患者为观察组（74例）,以排除APE的患者为对照组（74例）,两组患者均行D-二聚体测定及临床评分（改良Geneva评分）。结果观察组中,23例大面积APE患者经积极治疗后,21例痊愈,死亡2例,病死率为8.69%;51例非大面积APE的患者全部治愈,无一例死亡。74例APE患者的Geneva评分：0～3分4例（5.40%）;4～10分50例（67.57%）;≥11分20例（27.03%）。观察组的Geneva评分和血浆D-二聚体浓度均明显高于对照组（P〈0.01）。结论 D-二聚体测定联合改良Geneva评分对APE疑似患者的确诊有极大的临床意义,值得临床推广应用。     

Virtual pulmonary arterioscopy in pulmonary embolic disease

16 slice multidetector CT provides virtual endoscopic views of the inside of arteries, or any other hollow structures. This is performed non-invasively using post-processing of three-dimensional isotropic image data sets, acquired during standard CT examinations. These virtual endoscopic views are simultaneously correlated with the standard multiplanar reconstructions, with the ability to navigate a virtual camera through the hollow structure under study. Normal and abnormal volume rendered images of the pulmonary arteries are presented in correlation with the multiplanar reformats. The abnormal images show the volume rendered appearances of acute and chronic pulmonary embolic disease. It is also postulated that this technique has a problem solving role in the differential diagnosis of chronic mural emboli from extravascular structures such as adjacent lymph nodes or bronchiolar impaction. This technique may also have a role in medical education, providing clinicians and medical students with interactive three-dimensional representations of disease processes.     

Unusual pulmonary angiographic findings in suspected pulmonary embolism

Pulmonary arteriography is most commonly performed to diagnose pulmonary embolism. A variety of clinical entities, however, may mimic pulmonary embolism both clinically and scintigraphically. Five patients with abnormal pulmonary arteriograms resulting from diseases other than pulmonary embolism are presented. The clinical, radiographic, and pathologic findings and long-term follow-up in these patients are described. Awareness of the angiographic patterns seen in these unusual cases is important in the differential diagnosis of pulmonary thromboembolism.     

CT-determined pulmonary artery diameters in predicting pulmonary hypertension

This study was to determine if the diameters of pulmonary arteries measured from computed tomographic (CT) scans could be used 1) as indicators of pulmonary artery hypertension and 2) as a reliable base for calculating mean pulmonary artery pressure. The diameters of the main, left, proximal right, distal right, interlobar, and left descending pulmonary arteries were measured from CT scans in 32 patients with cardiopulmonary disease and in 26 age- and sex-matched control subjects. Diameters were measured using a special computer program that could display a CT density profile of the artery and its adjacent tissues. The upper limit of normal diameter for the main pulmonary artery was found to be 28.6 mm (mean + 2 SD). In the patient group, the diameters were correlated with data from cardiac catheterization. In these patients, a diameter of the main pulmonary artery above 28.6 mm readily predicted the presence of pulmonary hypertension. The calculated cross-sectional areas of the main and interlobar pulmonary arteries (normalized for body surface area [BAS]) were found to give the best estimates of mean pulmonary artery pressure (r = 0.89, P less than 0.001 and r = 0.66, P less than 0.001). Multiple regression analysis gave the useful equation: mean pulmonary artery pressure = -10.92 + 0.07646 X area of main pulmonary artery/BSA + 0.08084 X area of the right interlobar pulmonary artery/BSA (r = 0.93, P less than 0.0001). Because CT allows precise, noninvasive measurement of the diameter of pulmonary arteries, it can be of value in detecting pulmonary hypertension and estimating mean pulmonary artery pressure.     

Angiography and perfusion pulmonary scintigraphy in pulmonary embolism

Clinical signs suggestive of pulmonary embolism require diagnostic confirmation from complementary scintigraphic and/or angiographic examinations, therapy being adapted to the results obtained. A comparative study of the value of the two techniques was conducted in 20 patients with suspected pulmonary embolism investigated by a perfusion pulmonary scan and selective pulmonary angiography. Results confirmed the diagnostic superiority of angiography, the high percentage of false positives obtained by perfusion scintigraphy alone indicating the need for associated ventilatory function tests.     

The relationship between pulmonary artery pressure and pulmonary artery diameter in pulmonary hypertension

The pulmonary arteries dilate in response to many factors, principally increased pressure and flow. In patients who have pulmonary arterial hypertension but no increase in flow, we have compared main pulmonary artery size at computed tomography with pulmonary haemodynamic data obtained during right heart catheterisation. In patients with primary pulmonary hypertension and chronic thromboembolic pulmonary hypertension, dilatation correlated with raised pulmonary vascular resistance and reduced cardiac output but not with mean arterial pressure. In patients with chronic lung disease no correlations were shown though a trend between raised pressure and size was observed. We speculate that pulmonary artery compliance is an important factor which determines the degree of dilatation in response to raised pressure. Estimations of pressure cannot be made from measurements of pulmonary artery size without knowledge of the underlying lung disease.     

Follow-up pulmonary perfusion scintigraphy pulmonary arterial embolization in two cases of familial pulmonary arteriovenous fistula

Follow-up pulmonary perfusion scintigraphy in evaluating pulmonary arterial embolization were assessed by two cases of pulmonary familial arteriovenous fistula. Pulmonary arteriovenous fistula was found for brain abscess in the older brother, and for dyspnea on effort in the younger brother. Pulmonary arterial embolizations were performed. (older brother: 4 times, younger brother: 5 times) Before embolization, pulmonary perfusion scintigram showed pale defect, clear asymmetric perfusion between right and left lung, and clear renal visualization. On the other hand, after the embolization, clear multiple defects agreed with the sites of embolization, and asymmetric pulmonary perfusion and renal visualization disappeared. We conclude that follow-up pulmonary perfusion scintigraphy is useful to evaluate in pulmonary arteriovenous fistula after embolization.     

Quantitative lobar pulmonary perfusion assessment on dual-energy CT pulmonary angiography: applications in pulmonary embolism

To assess quantitative lobar pulmonary perfusion on DECT-PA in patients with and without pulmonary embolism (PE). Our retrospective study included 88 adult patients (mean age 56 ± 19 years; 38 men, 50 women) who underwent DECT-PA (40 PE present; 48 PE absent) on a 384-slice, third-generation, dual-source CT. All DECT-PA examinations were reviewed to record the presence and location of occlusive and non-occlusive PE. Transverse thin (1 mm) DECT images (80/150 kV) were de-identified and exported offline for processing on a stand-alone deep learning–based prototype for automatic lung lobe segmentation and to obtain the mean attenuation numbers (in HU), contrast amount (in mg), and normalized iodine concentration per lung and lobe. The zonal volumes and mean enhancement were obtained from the Lung Analysis™ application. Data were analyzed with receiver operating characteristics (ROC) and analysis of variance (ANOVA). The automatic lung lobe segmentation was accurate in all DECT-PA (88; 100%). Both lobar and zonal perfusions were significantly lower in patients with PE compared with those without PE (p < 0.0001). The mean attenuation numbers, contrast amounts, and normalized iodine concentrations in different lobes were significantly lower in the patients with PE compared with those in the patients without PE (AUC 0.70–0.78; p < 0.0001). Patients with occlusive PE had significantly lower quantitative perfusion compared with those without occlusive PE (p < 0.0001). The deep learning–based prototype enables accurate lung lobe segmentation and assessment of quantitative lobar perfusion from DECT-PA. • Deep learning–based prototype enables accurate lung lobe segmentation and assessment of quantitative lobar perfusion from DECT-PA. • Quantitative lobar perfusion parameters (AUC up to 0.78) have a higher predicting presence of PE on DECT-PA examinations compared with the zonal perfusion parameters (AUC up to 0.72). • The lobar-normalized iodine concentration has the highest AUC for both presence of PE and for differentiating occlusive and non-occlusive PE.     

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。     

MR灌注成像在肺栓塞诊断中的应用

目的探讨MR二维快速扰相梯度回波序列（2DFSPGR）显示肺实质灌注的可能性,以及在实验性肺栓塞中的应用价值。方法11只在体犬肺栓塞模型在平静呼吸下行肺MR灌注扫描,定性及定量评价图像质量,与病理解剖对照分析肺灌注扫描诊断肺栓塞的敏感性。结果10只犬的MR图像质量为优良,可显示肺实质灌注情况,平均信号/噪声比（SNR）为67.4±18.0,对比度/噪声比（CNR）为40.9±14.2。正常灌注区的信号强度平均值为39.7±5.1,灌注不良区域信号强度平均值为15.6±2.1,灌注不良区域时间-强度曲线表现为峰值下降或曲线平直。结论MR肺灌注成像是诊断肺栓塞的可行方法。