64层螺旋CT血管造影三维重建在肺栓塞检查中的临床应用

目的评价肺血管成像在肺栓塞中的临床应用价值。方法19例拟诊肺栓塞、4例拟诊冠心病患者行64层螺旋CT肺动脉造影,在工作站上对原始薄层图像进行后处理观察肺动脉栓子分布情况,其中5例同时行DSA检查,并与64层螺旋CT检查结果进行比较。结果全部病例三维肺血管图像均能充分显示肺动、静脉的空间关系与解剖细节,不但能准确、直观地观察肺血管,而且能明确诊断肺动脉栓塞及有无侧支循环形成。23例患者中检出肺动脉栓塞16例,共发现肺动脉栓子264处,其中段及段以上栓子149处,亚段及以下5~6级分支115处,血栓栓塞血管直径最小者1mm。1例上肢和胸侧壁因锁骨下静脉血栓明显侧支循环形成,1例左上肺静脉左房入口和左心耳内附壁血栓形成。5例同时行DSA检查,对肺段及段以下肺动脉栓子检出率,64层CT和DSA相比,均具有统计学差异。结论64层CT肺动脉造影对肺动脉主干、亚段及以下5~6级分支肺栓塞具有很好的应用价值,为肺部血管性疾病诊断与治疗提供重要依据。

Three-dimensional reconstruction of 64-slice spiral CT angiography in pulmonary embolism

Objective To evaluate the clinical value of three-dimensional imaging of pulmonary vessels with 64-slice spiral CT pulmonary angiography (64-MSCTPA) in pulmonary embolism (PE). Methods 64-MSCTPA was performed in 19 clinical suspected patients with PE and 4 with coronary heart disease. All the primitive images of pulmonary vessels and coronary artery were produced at the console workstation. The distribution of pulmonary vessels emboli was evaluated from different angle. Of 23 patients, PE were confirmed in 5 cases by DSA and compared with the findings of 64-MSCTPA. Results Spatial relationship and anatomical details of pulmonary arteries and veins could exactly be shown on all pulmonary vessels three-dimensional images in above-mentioned patients. On the basis of 64-MSCTPA, PE could be diagnosed definitely,in addition, collateral circulation formation could be clearly demonstrated. Of 23 patients, PE were found in 16 cases of PE were found by 64-MSCTPA. Two hundrends and sixty-four emboli were demonstrated in total, among which there are 149 emboli located in segmental ateries and 115 in subsegmental ateries (grade 5-6 branches).The minimal diameter of pulmonary atery with thrombus was 1 mm. Besides, apparent collateral circulation was displayed in 1 case between upper limb and lateral chest wall because of thrombus of subclavian and axillary vein, excentric filling defects of lumina were satisfactorily displayed in 1 case which located between the debouchement of left superior pulmonary vein and left atrium. There are distinguishedly statistical significance on the detection rate of emboli located in segmental atery and subsegmental atery between DSA and 64-MSCTPA. Conclusion 64-MSCTA has very high clinical value in detecting segmental and subsegmental pulmonary thrombi in PE patients, and provides useful information for the diagnosis and treatment of pulmonary vascular diseases.