慢性血栓栓塞性肺动脉高压的MSCT 诊断价值

目的：探讨 MSCT 诊断慢性血栓栓塞性肺动脉高压(CTEPH)的应用价值。方法回顾性收集 CTEPH 患者24例及其他原因肺动脉高压患者8例。分析 CTEPH 患者 CT 肺动脉造影(CTPA)图像特点,总结其直接和间接征象,并与非 CTEPH 患者进行对比。采用 SPSS17.0统计软件,对各项结果进行统计学分析。结果CTPA 24例,744支动脉；CTEPH 直接征象以附壁栓子为最多见,占受累支数的55.35%,其次为完全闭塞,部分充盈缺损,中心型部分充盈缺损,血管壁不规则增厚及偏心性充盈缺损；35.01%的栓塞血管管腔变细,0.89%的血管管腔扩张,无任何变化的占45.24%；CTEPH 最常见的间接征象为肺动脉增宽(100%)及右心增大(95.83%),其次为马赛克征,心包腔或胸腔积液,肺内磨玻璃样影,肺梗死及肺不张或实变。所有患者均有不同程度的肺动脉压力升高,最常见的 CTPA 征象依次为肺动脉增宽、右心室增大、下腔静脉及肝静脉显影、支气管动脉扩张及室间隔位置异常。结论(1)CTPA 能够清楚地显示 CTEPH 的类型、直接和间接影像学征象；(2)心脏的 CT 表现不足以鉴别 CTEPH 和非 CTEPH；(3)慢性肺栓塞的程度并不能够反映 CTEPH 的严重程度。

The value of MSCT in diagnosis of chronic thromboembolic pulmonary hypertension

Objective To explore the value of MSCT in diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH). Methods 24 patients with CTEPH and 8 patients with pulmonary hypertension by other causes were collected retrospectively.To analyzed the characteristics of CTPA images in patients with CTEPH,summarized the direct and indirect signs,and to compared with non-CTEPH.Statistical analysis was performed with SPSS1 7.0 software.Results According to the CTPA images,744 arteries of 24 patients with CTEPH were evaluated.The direct sign of CTEPH was mural thrombus firstly,accounted for 55.35% of the involved arteries,and then was followed by holo-obstruction,partial filling defect,central filling defect,irregular vessel wall thickening and eccentricity filling defect.There were narrowed lumens in 35.01%,dilated ones in 0.89% and no changes in 45.24%.The common indirect signs of CTEPH were pulmonary broadening (100%),enlargement of right heart (95.83%),mosaic attenuation,pericardial or pleural effusion,ground-glass opacity,infarction and atelectasis or consolidation in order.All patients had different degrees of pulmonary hypertension,and the most common findings of CTPA were widened pulmonary artery and enlarged right ventricle,and then were followed by enhancement of the inferior vena cava and hepatic vein,the expansion of bronchial artery and abnormal septal position.Conclusion CTPA can show the types and direct or indirect signs of CTEPH clearly.The morphological changes of the heart in CT are not enough to differentiate the CTEPH and non-CTEPH,and the severity of CTEPH is not alone decided by the degree of chronic pulmonary embolism.