肺栓塞的多排螺旋CT肺动脉造影诊断

目的探讨多排螺旋CT在肺栓塞诊断中的应用价值。方法对临床怀疑肺动脉栓塞经多排螺旋CT肺动脉造影(MSCTPA)及临床确诊的15例患者临床资料进行回顾性分析。结果15例肺栓塞患者中,14例诊断为肺栓塞,诊断率约93.3%。1035支肺动脉显示849支,显示率82%;肺栓塞130支,占显示肺动脉数的15.3%。其中亚段肺动脉600支中显示438支,显示率73%,栓塞43支占显示亚段肺动脉的9.8%。直接征象包括不同程度的充盈缺损及动脉断面变细,血管腔内密度不均匀减低。充盈缺损分为4种形式:中央性充盈缺损3例呈轨道征,偏侧性充盈缺损9例,附壁性充盈缺损2例,完全性阻塞3例。间接征象包括马赛克征1例,胸膜下楔形梗死灶3例,肺动脉高压5例,出现W esterm ark征8例,胸腔积液6例。结论MSCTPA是诊断肺栓塞快速、安全有效、无创的诊断方法,它将取代肺动脉造影成为肺栓塞诊断的首选手段。

Diagnosis of Pulmonary Embolism by Multidector Spiral CT Pulmonary Angiographgy

Objective To study the application of multidector spiral CT(MSCT) in the diagnosis of pulmonary embolism(PE).Methods The clinical and MSCTPA data of 15 cases with suspected PE were analyzed retrospectively.Results Of 15 cases,14 cases(93.3%)were diagnosed as PE.849 branches(82%) of pulmonary arteries were showed in 1035 branches.PE was detected in 130 branches(15.3%) of 849 branches of pulmonary arteries.438 branches(73%) were showed in 600 branches of subsegmental pulmonary arteries,PE was showed in 43 branches(9.8%)of 438 branches.Direct signs of PE included central filling defect in 3 cases;eccentric filling defect(n=9);embolism attached to the wall of host artery(n=2) and total occlusion of the pulmonary arteries(n=3).Indirect signs includedmosaic sign in 1 case;subpleural infarction(n=3);pulmonary hypertension(n=5);Westermark sign(n=8) and pleural effusion(n=6).Conclusion MSCTPA is a fast,effective,security and non-invasive diagnostic method for PE,it may replace the pulmonaryangiography and will be the first choice for diagnosis of PE.