肺栓塞诊断:单层、多层螺旋CT的对比研究

目的:研究并对比分析多层、单层螺旋CT肺动脉造影(multi-slice and single-slice spiral CT pulmonary angiography,MSCTPA and SSCTPA)对肺栓塞(pulmonary embolism,PE)诊断的临床价值。方法:回顾性分析临床明确诊断的83例PE患者的螺旋CT肺动脉造影表现,其中行16层MSCTPA及SCTPA检查者各为23和60例。结果:分析83例PE患者的3548支肺动脉,MSCTPA、SCTPA共显示759支PE直接征象(包括中心型充盈缺损95支、部分型充盈缺损230支、完全性阻塞251支、附壁性充盈缺损183支),约占23.3%;其中1885支段以上肺动脉中,MSCTPA、SCTPA分别检出157支和371支PE直接征象,各占32.6%(157支/481支)和26.4%(371支/1404支),经过t检验,t=1.3220.1,两者检出率无明显差别;1663支亚段肺动脉中,MSCTPA、SCTPA分别检出123支和108支PE直接征象,各占25.0%(123支/492支)和9.2%(108/1171支),t=3.125>t0.01(81)=2.374,P<0.01,前者检出率明显高于后者。平扫示间接征象共160例次。结论:作为一种快速、无创的检查方法,MSCTPA、SCTPA对段以上PE的诊断均有效、准确、可靠,而MSCTPA对亚段PE的显示更为敏感,适用于临床对PE的全面评价。

The diagnosis of pulmonary embolism: comparison of multi-slice and single-slice spiral CT

Objective:To evaluate and compare the clinical applications of multi-slice and single-slice spiral CT pulmonary angiography(MSCTPA and SCTPA) in the diagnosis of pulmonary embolism(PE).Methods:The manifestations of spiral CT pulmonary angiography with 83 cases whose were proved by clinical were analyzed retrospectively.Among them,23 cases and 60 cases were examined by multi-slice and single-slice spiral CT pulmonary angiography(MSCTPA,SCTPA),respectively.Results:3548 pulmonary arteries of 83 patients with PE were analyzed.Direct manifestations(including 95 central filling defects,230 partial filling defects,251 total occlusion and 183 mural filling defects)were showed in 759 pulmonary arteries(759/3548,23.3%) by MSCTPA and SCTPA.157/481(32.6%) and 371/1404(26.4%) direct manifestations were displayed respectively by MSCTPA and SCTPA in 1885 superior segmental pulmonary arteries.There were no remarkable difference between MSCTPA and SCTPA(t test,t=1.3220.1).123/492(25.0%) and 108/1171(9.2%) direct manifestations were displayed respectively by MSCTPA and SCTPA in 1663 inferior segmental pulmonary arteries.MSCTPA detected more direct manifestations than SCTPA(t=3.125>t0.01(81)=2.374,P<0.01).174 indirect signs were showed by CT plain scan.Conclusion:Spiral CT pulmonary angiography is a rapid and noninvasive method in diagnosing PE.Both MSCTPA and SCTPA are effective,accuracy and reliable in diagnosing PE in superior segmental pulmonary arteries.MSCTPA is more sensitive to diagnose PE in inferior segmental pulmonary arteries.It is more suitable for properly evaluate PE.