多层螺旋CT血管造影对肺动脉栓塞诊断和疾病严重程度的评价价值

目的 探讨多层螺旋CT血管造影(CTA)对肺动脉栓塞的诊断价值,评价肺动脉栓塞CTA表现与疾病严重程度的关系.方法 回顾性分析肺动脉栓塞36例临床和影像资料,所有患者均使用GE LightSpeed 64层螺旋CT或e-Speed电子束CT行常规扫描及CTA,横轴位图像和多种后处理技术观察肺动脉改变及相关征象.结果 36例共2 070支肺动脉纳入分析,748支显示了栓塞,占36.1%.216支肺叶动脉中,75支显示了栓塞(34.7%),720支肺段动脉中,319支显示了栓塞(44.3%),1 134支亚段肺动脉中,354支显示了栓塞(31.2%).根据临床表现将患者分为危重组和非危重组.危重组15例,肺动脉栓塞指数为(56.7 4±11.3)%,中央肺动脉受累39支(43.3%),右心室最大短轴和左心室最大短轴比(RV:LV比)为(1.46±0.62).非危重组21例,肺动脉栓塞指数为(27.4±9.6)%,中央肺动脉受累36支(28.6%),RV:LV比为(1.06±0.35),两组指标测量结果差异均有统计学意义.结论 多层螺旋CT血管造影可直观地显示有无肺动脉栓塞、病变范围和严重程度,肺动脉栓塞指数>40%可作为诊断大面积肺动脉栓塞的重要指标.

Multislice spiral CT angiography in diagnosis and severity assessment of pulmonary embolism: report of 36 cases

Objective To study the diagnostic value of multislice spiral CT angiography ( CTA) in the diagnosis and severity assessment of pulmonary embolism ( PE ). Methods Clinical and imaging data of 36 cases of PE admitted in our hospital during May 2005 to March 2009 were reviewed retrospectively. All patients underwent conventional CT scanning and CTA with 64-slice spiral CT or e-Speed electron beam CT scanning ( GE Medical System, Milwaukee, WI). Axial section and some post-processed images, including maximum intensity projection ( MIP) , multiplanar reconstruction ( MPR), volume rendering (VR) and virtual endoscopy ( VE) were analyzed. Results In 36 cases of PE, 2 070 branches of pulmonary artery were analyzed and PE was detected in 748 branches (36. 1% ). In 216 lobar arteries, PE was detected in 75 branches (34. 7% ) , in 720 segmental arteries PE was detected in 319 branches (43.3% ) , and in 1 134 subsegmental arteries PE was detected in 354 branches (31. 2% ). Based on clinical manifestations the patients were classified into 2 groups, severe group and non-severe group. In 15 cases of severe group, pulmonary embolism index was (56.7± 11.3)% , the central pulmonary artery was involved in 39 branches (43. 3% ), and the right ventricle/left ventricle maximum minor axis ratio ( RV: LV ratio) 1.46 ±0. 62. In 21 cases of non-severe group, pulmonary embolism index was (27.4±9.6)% , central pulmonary artery was involved in 36 branches (28.6% ), and the RV: LV ratio was 1.06±0. 35. The difference of the parameters between 2 groups was statistically signifi-cant (P <0.05, 0.01). Conclusion Multislice spiral CT angiography displays PE intuitively and determines its extent and severity. Our data suggest that pulmonary embolism index >40% can be used as the important criteria for the diagnosis of large area PE.