64层螺旋CT三维血管成像对肺动脉栓塞诊断与溶栓治疗的评价

目的探讨64层螺旋CT三维血管成像（SCTPA）对肺动脉栓塞的诊断,并对溶栓治疗前后临床疗效作出评价。方法临床怀疑肺动脉栓塞患者30例,经64层SCTPA检查确诊20例;回顾性分析其成像条件及各种后处理方法对肺动脉及其栓子的显示情况,并对20例治疗前后图像对比的病例进行临床疗效评价。结果 30例SCTPA图像质量均满足诊断需要;薄层容积图像及后处理图像均可清晰显示肺动脉及其各级分支,显示率为100%;病变共累及79支肺动脉,其中,左右肺动脉9支、肺叶及中间动脉36支、肺段动脉25支、亚段动脉9支。15例治疗后复查,急性肺栓塞12例,药物治疗及导管法溶栓效果均良好;3例慢性肺栓塞,药物及导管法治疗效果较差。结论 64层螺旋SCTPA是目前诊断肺动脉栓塞最为快捷、安全、可靠的影像方法,对急慢性肺栓塞的诊断可为临床治疗方案的制定提供参考,其急性肺栓塞应及早抗凝和溶栓,可取得较满意的疗效。

Role of 64-slice spiral CT three-dimensional blood vessel imaging pulmonary angiography in the diagnosis and the evaluation to the efficacy of pulmonary embolism

Objective To investigate the role of 64-slice spiral CT three-dimensional blood vessel imaging pulmonary angiography in the diagnosis and the evaluation to the efficacy of pulmonary embolism（PE）.Methods Among the 30 cases with suspicious PE,20 patients were defined PE by 64 slice spiral CTPA.Retrospectively analyzed the scanning plans of 64 slice spiral CTPA,and the displaying of the pulmonary artery and the embolism and thin-ner slice volume imaging,the application of some restructures methods such as MPR,MIP,VR,then evaluated 10 patients the effect of thrombolytic therapy.Results The quality of all SCTPA imaging were well-pleasing for the diag-nosis.The view of the main pulmonary artery and its branches were showing clearly by these methods mentioned above,the showing ratio was 100%.In 20 patients with PE,79 branches of pulmonary embolism were identified,including 9 aortopulmonay arteries,36 lobar arteries,25 segmental pulmonary arteries and 9 subsegmental pulmonary arteries.The medicine and transcatheter therapy effect of 12 actute PE were favorable,the 3 chronic were unsatisfied.Conclusion 64-slice spiral CTPA is a the optimal modality for detecting PE currently,with the fast,effective,reliable and non-invasive feature.The diagnosis of acute or chronic PE is helpful for choosing the therapy plan.