前瞻性心电触发大螺距CT肺动脉成像对肺栓塞的诊断价值

 目的探讨第2代双源CT前瞻性心电触发大螺距扫描（Flash模式）肺动脉成像对肺栓塞的诊断价值。方法回顾性分析19例行双源CT前瞻性心电触发大螺距扫描肺动脉成像并诊断肺栓塞患者的影像资料，总结肺栓塞的直接、间接征象及分型。结果19例肺栓塞共显示肺动脉1614支，发现栓子381支，栓塞发生率为23.6%。381支栓子中累及肺动脉主干1支，左右肺动脉干7支，叶肺动脉16支，段肺动脉83支，亚段肺动脉274支。直接征象为肺动脉管腔内的充盈缺损，其中中心型113支（占29.7%），偏心型24支（占6.3%），混合型8支（占2.1%），闭塞型236支（占61.9%）。间接征象包括马赛克征1例，肺梗死2例，肺动脉高压1例，胸腔积液7例。结论双源CT前瞻性心电触发大螺距扫描肺动脉成像简单、快捷、安全、无创，可清晰显示肺动脉栓子，对诊断肺栓塞有重要价值。

The Diagnostical Significance of Dual-source CT Angiography with Prospectively Electrocardiogram-triggered High-pitch Spiral Protocol in Pulmonary Embolism

Objective To evaluate the significance of second-generation dual-source CT angiography with prospectively ECG-triggered high-pitch spiral protocol (Flash mode) in the diagnosis of pulmonary embolism. Methods The patients with pulmonary embolism of 19 cases using second-generation dual-source CT with prospectively ECG-triggered high-pitch spiral protocol were analyzed retrospectively. The direct signs,indirect signs and types of pulmonary embolism were summarized. Results A total of 1614 branches of pulmonary arteries were discovered in the 19 patients. A total of 381 embolisms were discovered by dual-source CT. Incidence of embolism was 23.6%. The 381 pulmonary embolism involved 1 branch in pulmonary trunk,7 in left and right pulmonary trunk,16 in lobar pulmonary artery,83 in segmental pulmonary artery,and 274 in subsegmental pulmonary artery. The direct signs of pulmonary embolism were filling defect in pulmonary artery,including central filling defect in 113 branches (29.7%),eccentric filling defect in 24 branches (6.3%),mixed defect in 8 branches (2.1%),complete occlusion of pulmonary arteries in 236 branches (61.9%). The indirect signs included 1 case of mosaic sign,2 cases of pulmonary infarction,1 case of pulmonary hypertension,and 7 cases of pleural effusion. Conclusion The prospectively ECG-triggered high-pitch spiral acquisition of dual-source CT angiography is a convenient,fast,safe,non-invasive and reliable method for demonstration of pulmonary embolism and plays an important role in the diagnosis of pulmonary embolism.