不同影像学方法对急性肺血栓栓塞症的诊断价值

目的探讨急性肺血栓栓塞症（PTE）诊断中不同影像学方法的价值。方法收集近2年诊断的22例急性PTE病人的临床资料，除4例因病情危重不能进一步检查仅行临床诊断外（其中2例尸检证实），其余18例均采用螺旋CT肺动脉造影（CTPA）、超声、放射性核素扫描、肺动脉造影等至少两种以上方法诊断，分析不同诊断方法的急性PTE诊断阳性率。结果18例患者中，15例行CTPA，诊断肺栓塞12例，阳性率为80％。核素扫描14例，其中肺通气／灌注扫描9例，单纯肺灌注扫描5例，诊断肺栓塞13例，阳性率为92．9％。10例行核素扫描患者同时行下肢深静脉造影，5例发现深静脉血栓；5例表现为侧支循环形成，血流受阻，管腔狭窄，瓣膜功能异常等改变。心脏彩超检查16例，仅1例发现血栓，8例表现为右心室扩大、肺动脉高压、三尖瓣反流等PTE的间接表现，2例正常，肺栓塞诊断率为56％（9／16）。10例行下肢静脉彩色多普勒超声检查，6例发现深静脉血栓，1例瓣膜功能不全。结论CTPA对急性PTE的诊断阳性率较高，是诊断PTE的有效手段，具有无创、快捷、方便、可靠等特点，可作为一线检查手段。核素扫描的同时行下肢静脉造影，对急性PTE的诊断率也很高，同时减少了诊断步骤。

The value of different imageology methods in the diagnosis of acute pulmonary thrombo embolism

Objective To assess the value of different imageology methods in the diagnosis of acute pulmonary thromboembolism(PTE).Methods 22 cases diagnosed as acute PTE in the last two years were retrospectively analysed.In these subjects 4 cases were diagnosed by clinical signs and symptoms without further examinations due to severe disease(2 cases confirmed by autopsy),18 cases were diagnosed by either two methods of computed tomographic pulmonary angiography(CTPA),ultrasound,lung radioisotope scanning and pulmonary arteriography.The diagnostic positive rate of different methods were measured.Results 15 of the 18 subjects were performed CTPA with a positive rate of 80%(12/15).Rradioisotope scanning was performed in 14 cases,in which 5 cases were performed simple pulmonary perfusion scanning,9 cases by lung ventilation/perfusion scanning,resulted in a positive rate of 92.9%(13/14).10 cases were performed nuclide phlebography on the low extremity simultaneously,by which deep phlebothrombosis was found in 5 subjects,abnormal formation of collateral circulation,blocked blood circulation,stenosis of lumens,and valve disfunction were found in other 5 cases.16 cases were performed heart color ultrasound detection,by no abnormality was found in 2 cases and thrombus was directly found in one case.Indirect manifestations of acute PTE including right ventricular enlargement,pulmonary artery hypertension,tricuspid backstreaming were found in other 8 cases with a diagnosing rate of 56%(9/16).Deep phlebothrombosis was found in 6 of the 10 cases who were performed color Doppler ultrasonography on the lower extremity while valve dysfunction was found in one case.ConclusionsCTPA could be used as the firstline approach for diagnosing acute PTE because of high sensitivity,reliability along with promptness and convenience.Lung radioisotope scanning associated with real-time phlebography on the low extremity also has fairly high positive yield in diagnosing acute PTE.