多层螺旋CT上急性肺动脉栓塞病人的支气管动脉扩张：与慢性及复发性病例的比较

以往研究认为，慢性肺血栓栓塞病例的螺旋CT肺动脉造影检查可见扩张的支气管动脉。迄今为止，尚未见关于急性肺动脉栓塞(PE)病例支气管动脉CT表现的报道。本研究观察了PE病例支气管动脉的多层螺旋CT(MDCT)肺动脉造影表现，并比较急性PE与慢性及复发性病例的支气管动脉表现。     

冠状动脉起源于肺动脉的影像学研究

目的 探讨冠状动脉(简称冠脉)起源于肺动脉(ACAPA)影像学诊断方法的价值。方法 回顾性分析11例ACAPA的影像学表现。11例均行X线胸片、超声心动图(Echo)和心血管造影检查，其中1例行电子束CT(EBCT)检查。结果 10例为左冠脉起源于肺动脉，1例为右冠脉起源于肺动脉。11例胸片均未确诊，Echo诊断3例，EBCT诊断1例。心血管造影全部诊断正确，其中左冠脉异常起源者左冠脉均发自主肺动脉后窦或后壁，通过扩张的右冠脉藉侧支逆行充盈；右冠脉异常起源者右冠脉从主肺动脉右窦发出。手术与造影所见相同。3例前乳头肌缺血性纤维化，二尖瓣环扩大，前叶脱垂致二尖瓣关闭不全。结论 X线胸片诊断受限，Echo简便、无创，但操作技术及认知水平有待提高。心血管造影仍是术前确诊的“金标准”。     

电子束CT诊断主动脉-肺动脉间隔缺损的价值

目的评价电子束CT（EBCT）对主动脉．肺动脉间隔缺损（APSD）及其合并畸形的诊断价值。方法7例APSD患者，年龄1～13岁。均行X线平片、超声心动图及EBCT检查。心电门控EBCT血管造影采用270mg I／ml非离子型对比剂碘海醇，层厚1．5～3．0mm。其中3例行心血管造影检查，2例有手术对照。将同一患者的各项影像学检查结果及手术所见进行比较并分析。结果7例主-肺动脉间隔缺损EBCT全部诊断，2例经手术证实；3例经心血管造影检查证实；超声心动图仅检出2例。同时，EBCT检查示4例合并右肺动脉起源异常、主动脉弓离断；5例合并动脉导管未闭，均经手术和（或）造影证实；超声心动图检查漏诊右肺动脉起源异常2例，漏诊主动脉弓离断2例；心血管造影漏诊动脉导管未闭1例。结论X线平片、超声心动图、心血管造影及EBCT综合影像诊断是必要的，作为无创性检查方法，EBCT在主动脉-肺动脉间隔缺损及其合并畸形诊断有重要价值。     

先天性一侧肺动脉缺如的电子束CT诊断

目的 评价电子束CT(EBCT)诊断先天性一侧肺动脉缺如的价值。方法 对经平片、超声心动图检查后拟诊为肺血管疾病或原发性肺动脉高压的患者行EBCT检查，EBCT诊断先天性一侧肺动脉缺如的11例患者入选，并与超声心动图、核素通气灌注扫描、心血管造影的检查结果作进一步的比较及评估。结果 单发一侧肺动脉缺如4例，均为女性成年人。合并多发心血管畸形7例，其中合并复杂畸形3例，均为男性儿童和左肺动脉缺如；合并单发心血管畸形4例，其中3例为右肺动脉缺如。结论 (1)儿童时期明确诊断的一侧肺动脉缺如多合并有心血管畸形，且左肺动脉缺如多见，成年人明确诊断的单发一侧肺动脉缺如多为右肺动脉缺如。(2)EBCT对先天性一侧肺动脉缺如的诊断有较高的实用价值，较之多普勒超声更为准确，与心血管造影各具独特优势，但EBCT为无创检查是其特点。     

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。     

左下肺动脉吊带的彩色多普勒超声心动图诊断价值分析

目的探讨多普勒超声心动图对左下肺动脉吊带(left lower-lobe pulmonary artery sling,LLPAS)的诊断价值,分析超声心动图漏、误诊的原因,旨在提高超声对LLPAS诊断的准确性。方法回顾性分析9例经心脏CT检查及外科手术证实为LLPAS患儿的超声心动图检查资料。结果 9例患儿中,1例为单纯性LLPAS,8例合并其他心血管畸形,常见的合并畸形有房间隔缺损或卵圆孔未闭6例、室间隔缺损5例、肺动脉高压4例,主动脉瓣狭窄3例,主动脉缩窄3例,动脉导管未闭2例。超声声像图特征为左上肺动脉发自肺动脉总干,左下肺动脉发自右肺动脉。9例LLPAS患儿超声心动图诊断正确6例,占66.67%;误诊、漏诊共3例,占33.33%;其中2例误诊为左肺动脉发育不良,1例漏诊。9例患者均行心脏CT检查,心脏畸形与外科手术发现均相同,诊断符合率100%;CT诊断气管狭窄3例;气管狭窄超声心动图检查均未显示。结论超声心动图可以诊断LLPAS,但容易漏误诊。     

64排螺旋CT在肺动脉栓塞诊断中的应用

目的：研究64排螺旋CT肺动脉造影对肺动脉栓塞患者诊断的临床应用价值。方法：收集经临床及实验室检查并随访确诊肺动脉栓塞患者36例行对比剂增强64排螺旋CT肺动脉造影扫描。结果：36例肺动脉栓塞患者中,64排螺旋CT肺动脉造影共检出173处累及肺动脉及其分支,其中肺动脉主干0处,左、右肺动脉主干处7处,肺叶动脉68处,肺段动脉82处,亚肺段动脉16处;173处病变中,中心性充盈缺损78处,偏心性充盈缺损61处,完全梗阻性充盈缺损34处,结论：64排螺旋CT肺动脉造影技术具有快速、准确、无创等优点,目前已经成为临床诊断肺动脉栓塞及观察疗效的首选方法。     

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。     

左冠状动脉异常起源于肺动脉的影像学诊断

目的评价影像学对左冠状动脉起源于肺动脉的诊断价值。资料与方法回顾性分析1995至2004年的3例经手术治疗患者,全部行心血管造影及彩色多普勒超声心动图检查,2例行MRA检查。结果心血管造影（逆行主动脉造影2例,选择性右冠状动脉造影1例）均显示良好,并明确诊断。彩色多普勒超声心动图,1例明确诊断,2例误诊为右冠状动脉-右心室瘘。MRA1例显示良好,另1例未能清晰显示。结论左冠状动脉起源于肺动脉罕见,心血管造影仍然是诊断的金标准,但MRA及彩色多普勒超声心动图是有用的非创伤性的诊断方法。     

主肺动脉间隔缺损的超声心动图诊断价值及漏误诊分析

目的探讨多普勒超声心动图对主肺动脉间隔缺损(aortopulmonary septal defect,APSD)的诊断价值,分析漏诊、误诊原因,提高超声心动图对APSD诊断的准确性。方法回顾性分析60例经心外科手术或CT检查诊断为APSD患儿的超声心动图资料。结果 APSD的声像图特征主要表现为:主肺动脉间隔存在缺损、双向分流及肺动脉高压。本组单纯性APSD 17例,合并其它心脏畸形者43例(71. 7%);常见的合并畸形有右肺动脉异常起源于升主动脉16例、主动脉弓中断或主动脉缩窄13例、室间隔缺损9例、房间隔缺损/卵圆孔未闭9例、动脉导管未闭7例、肺动脉闭锁伴室间隔缺损1例。Mori分型Ⅰ型15例,Ⅱ型42例,Ⅲ型3例。超声心动图诊断正确55例(91. 7%);漏、误诊5例(8. 3%),其中漏诊3例(5. 0%),误诊2例(3. 3%)。结论彩色多普勒超声心动图可以比较准确地诊断主肺动脉间隔缺损。     

Obstruction of pulmonary arteries. Contribution of the scanner and MRI. Apropos of 10 cases

We present a retrospective study of ten patients presenting non specific clinical manifestations in whom the diagnosis of pulmonary embolism was documented by CT scan and/or MRI. Results of CT scan and/or MRI were compared to DSA bi-selective pulmonary angiography findings. In a large number of cases, CT scan and MRI allowed the detection of the obstruction within the right and left pulmonary arteries (RPA and LPA). Although these techniques did not permit the diagnosis of peripheral clots, pulmonary infarcts were usually depicted by these two procedures. CT scan and/or MRI could be performed as first-line investigations in case of atypical clinical symptoms because of their high relevance for proximal pulmonary artery obstruction, although these two non-invasive procedures cannot indicate the aetiology of the obstruction etiology.     

Comparison of computed tomography and cineangiography in the demonstration of central pulmonary arteries in cyanotic congenital heart disease

Purpose: To assess the diagnostic accuracy of contrast-enhanced computed tomography (CT) for central pulmonary artery pathology in patients with cyanotic congenital heart disease (CCHD) and right ventricular outflow obstruction. Methods: We compared contrast-enhanced CT and cine pulmonary arteriography in 24 patients with CCHD to assess central pulmonary arteries including the confluence. Both investigations were interpreted by a cardiac radiologist in a double-blinded manner at an interval of 3 weeks. Angiography was used as the gold standard for comparison. Results: The sensitivity for visualization of main pulmonary artery (MPA), right pulmonary artery (RPA), left pulmonary artery (LPA), and confluence on CT was 94%, 100%, 92.8%, and 92.8%, respectively. Diagnostic specificity for the same entities was 28.5%, 100%, 80%, and 50%, respectively. The positive predictive value for each was 76.2%, 100%, 94.1%, and 72.2%, respectively. The low specificity of CT in the evaluation of the MPA and the confluence is perhaps due to distorted right ventricular outflow anatomy in CCHD. Large aortopulmonary collaterals in this region were mistaken for the MPA in some patients with pulmonary atresia. Conclusion: CT is a useful, relatively noninvasive, imaging technique for the central pulmonary arteries in selected patients. It can supplement diagnostic information from angiography but cannot replace it. LPA demonstration on axial images alone is inadequate.     

Proximal pulmonary artery blood flow characteristics in healthy subjects measured in an upright posture using MRI: the effects of exercise and age

PURPOSE: To use MRI to quantify blood flow conditions in the proximal pulmonary arteries of healthy children and adults at rest and during exercise in an upright posture. MATERIALS AND METHODS: Cine phase-contrast MRI was used to calculate mean flow and reverse flow index (RFI) in the main (MPA), right (RPA), and left (LPA) pulmonary arteries in healthy children and adults in an open-MRI magnet equipped with an upright MRI-compatible ergometer. RESULTS: From rest to exercise (150% resting heart rate), blood flow (liters/minute/m2) increased in the RPA (1.4+/-0.3 vs. 2.5+/-0.4; P<0.001), LPA (1.1+/-0.3 vs. 2.2+/-0.6; P<0.001), and MPA (2.7+/-0.5 vs. 4.9+/-0.5; P<0.001). RFI decreased in the LPA (0.040+/-0.030 vs. 0.017+/-0.018; P<0.02) and MPA (0.025+/-0.024 vs. 0.008+/-0.007; P<0.03). Adults experienced greater retrograde flow in the MPA than the children (0.042+/-0.029 vs. 0.014+/-0.012; P<0.02). CONCLUSION: It appears that at both rest and during exercise, in children and adults alike, RPA/LPA mean blood flow distribution is predominantly determined by distal vascular resistance, while retrograde flow is affected by proximal pulmonary bifurcation geometry.     

Angiosarcoma of the pulmonary trunk mimicking pulmonary thromboembolic disease. A case report

We report on a 59-year-old male patient who suffered from dyspnea, cough and hemoptysis. Initial chest X-ray revealed a prominent right pulmonary artery (RPA) and MR imaging showed a “filling defect” within the main pulmonary trunk and RPA indicating pulmonary thromboembolic disease. Despite systemic anticoagulation, symptoms progressed. Follow-up CT showed an enlarging “filling defect” with additional extension into the left pulmonary artery as well as multiple intrapulmonary nodules. Lesion biopsy revealed a pulmonary artery angiosarcoma. Imaging findings are presented. Our case illustrates that pulmonary artery angiosarcoma should be included in the differential diagnosis of pulmonary thromboembolic disease in cases where a) symptoms do not respond to anticoagulation, b) no source of thrombi/emboli can be detected and c) pulmonary nodules/metastases develop on follow-up.     

64层螺旋CT心胸联合造影在急性胸痛病因鉴别诊断中的价值

目的 探讨64层螺旋CT在急性胸痛病因鉴别诊断中的临床价值。方法 对36例临床急性胸痛的患者行64层螺旋CT心胸联合血管造影检查。对所有扫描原始数据用冠状、矢状面多平面重组（MPR）、曲面重组（CPR）、容积再现（VR）和最大密度投影（MIP）等方法行冠状动脉、肺动脉和胸主动脉成像。由2名有经验的放射科医生对所有图像进行观察，对疾病进行诊断，其中16例患者同时行选择性血管造影检查。结果 所有行64层螺旋CT心胸联合血管造影的患者1次检查均可清晰显示双侧肺动脉、冠状动脉主干及其主要分支以及胸主动脉，同时均可进行纵隔及肺窗重组，对胸部疾病进行诊断。显示冠状动脉狭窄10例，急性肺动脉栓塞14例，主动脉夹层6例（其中1例同时伴有冠状动脉右支急性血栓形成）；并诊断气胸1例、缩窄性心包炎1例；4例未见明显异常。结论 64层螺旋CT1次心胸联合血管造影检查能清晰地显示冠状动脉、肺动脉及主动脉，对其病变作出正确诊断，还能清晰地显示胸部疾病，是急性胸痛病因诊断无创、可靠的检查方法。     

Adult presentation of right lung agenesis and left pulmonary artery sling

The combination of right lung agenesis and left pulmonary artery (LPA) sling is a rare entity that has been described only in the pediatric population. Cross-sectional imaging modalities such as magnetic resonance imaging (MRI) and computed tomography (CT) have an advantage over echocardiography and pulmonary angiography in demonstrating the anomalous left pulmonary artery, particularly in the presence of coexisting lung agenesis, as exemplified in this case. We report the first case of this rare entity in an adult. It is important to be aware that this abnormality, though rare, can present even in adulthood, and therefore close attention should be paid to the course of the pulmonary artery to ensure detection of a sling in association with lung agenesis.     

CTA与经胸超声心动图在法洛四联症及其并发畸形诊断中的应用价值

目的:分析CTA与经胸超声心动图(TTE)在法洛四联症(TOF)及其并发畸形中的应用价值.方法:将35例TOF患儿作为研究对象,以心导管造影及手术结果作为对照,回顾性分析CTA与TTE对TOF及其并发畸形的检出率,以及相关解剖结构测量结果的差异.结果:35例CTA与TTE的检出率均达100.0％.经心导管造影及手术证实...     

外周性原始神经外胚层瘤的影像表现

目的:探讨外周性原始神经外胚层肿瘤的影像学表现.方法:回顾性分析经病理证实的12例外周性神经外胚层瘤的影像学资料.9例行CT扫描,4例行MR扫描,其中1例行DSA检查.结果:胸壁软组织5例,右肺下叶1例,肱骨2例,股骨1例,胫骨1例,脊椎2例.胸壁软组织的pPNETs CT平扫表现为大而边界欠清的软组织肿块,内见坏死,无钙化,增强后明显不均匀强化.右肺下叶的pPNETs CT平扫表现为分叶状肿块,内见少量出血,边界清晰,增强后明显强化.长骨pPNETs表现为溶骨性骨质破坏伴巨大软组织肿块,无钙化,无骨膜反应.T1WI上表现为等或低信号,T2 WI上表现为不均匀高信号,增强后明显强化.脊椎pPNETs表现为椎体或附件骨质破坏伴软组织肿块,不累及椎间盘,其中1例骶骨pPNETs DSA检查示肿瘤由髂内动脉供血和大量新生血管.结论:CT和MRI均能很好地显示pPNETs的内部结构、病变范围、有无侵犯毗邻组织器官或远处转移.DSA可明确肿瘤供血动脉和反映新生肿瘤血管丰富的特点,可作为一种补充检查方法.确诊仍需依靠病理和免疫组化检查.     

Improving CT assessment for pulmonary hypertension in patients with severe aortic stenosis,correlation with right heart catheterization

PurposeTo identify CT parameters useful for assessment of pulmonary hypertension (PH) in patients with severe aortic stenosis (AS).Materials and methodsRetrospective study of 165 patients who had undergone right heart catheterization (RHC), and CTA of the thorax for preoperative aortic valve replacement (TAVR) planning. These were divided into groups based on mean pulmonary artery (PA) pressure (mPAP) of 25 mm Hg on RHC (85 cases and 80 controls). Diameters of main pulmonary artery diameter (MPAD), left pulmonary artery (LPA), right pulmonary artery (RPA), and maximal long axis and short axis diameters of the right atrium (RA) and ventricle (RV) were measured on the axial plane. Univariate and multivariate statistical analysis was utilized to identify metrics predictive of PH.ResultsMPAD, LPA, and RPA were higher in subjects with mPAP >25 mm Hg (p < 0.0001 for all). Thresholds of 30.5 mm for MPAD (68.4% sensitivity, 82.7% specificity), and 27.5 mm for LPA and RPA (LPA: 51.9% sensitivity, 78.8% specificity; RPA: 62.0% sensitivity, 78.8% specificity) provided the best discrimination of elevated mPAP. Compared to literature values for MPAD (28.9 mm in men and 26.9 mm in women), these thresholds provide lower sensitivity but greatly increased specificity. Inclusion of RA enlargement to MPAD increased specificity to 98.5%, while inclusion of RV enlargement increased specificity to 100%.ConclusionThreshold to identify PH in patients with AS using PA enlargement is higher than previously reported range for normal. Inclusion of RA and RV enlargement improves the ability of CT to more accurately identify PH in patients with AS.     

16排螺旋CT在高危胸痛诊断中的应用

目的:通过一次CT扫描同时完成冠状动脉、主动脉和肺动脉CTA检查,鉴别上述高危胸痛,探讨16排螺旋CT在高危胸痛诊断中应用价值。方法:2005年12月~2008年6月住院及急诊胸痛患者46人。应用两种方法行行一次性胸痛三联检查。结果:46例患者一次检查均可清晰显示肺动脉段以上分支、胸主动脉及冠状动脉左右主干及主要分支。共发现冠状动脉狭窄42例,肺动脉栓塞5例,主动脉夹层2例。结论:16排螺旋CT一次动脉期增强扫描显示肺动脉、胸主动脉及冠状动脉,对胸痛病因的诊断及鉴别诊断具有重要意义。