老年肺栓塞的螺旋CT肺动脉造影诊断研究

目的探讨螺旋CT肺动脉造影在老年肺动脉栓塞(PE)诊断中的临床应用价值。方法采用螺旋CT对66例老年PE患者行肺动脉增强扫描,其中多层、单层螺旋CT(MSCT,SCT)肺动脉造影检查者各为21和45例。结果分析66例老年PE患者的2728支肺动脉,MSCT、SCT肺动脉造影共显示926支肺动脉受累。直接征象为中心型充盈缺损、部分型充盈缺损、完全性阻塞、附壁性充盈缺损,约占33.9%;1206支段以上肺动脉中,依据直接征象MSCT、SCT分别检出240支/384支(62.5%)和481支/822支(58.5%),共721支/1206支,两者检出率无明显差别(P=0.037);1522支亚段肺动脉中,MSCT、SCT分别检出121支/484支(25.0%)和84支/1038支(8.1%),共205支/1522支,前者检出率明显高于后者(P=0.632)。平扫示间接征象共125例次。结论MSCT、SCT对段以上PE的诊断二者均有较高的准确度,MSCT对亚段PE的诊断有其优势。

The diagnostic value of spiral CT pulmonary angiography in elderly pulmonary embolism

Objective To evaluate the clinical application of spiral CT pulmonary angiography in the diagnosis of pulmonary embolism(PE) in elderly.Methods Sixty-six old patients with PE were studied by spiral CT pulmonary angiography. Of them, 21 cases and 45 cases were examined by multi-slice spiral CT (MSCT) and single-slice spiral CT (SCT), respectively.Results A total of 2728 pulmonary arteries of 66 PE elderly patients were analyzed. Direct manifestations(including central filling defect, partial filling defect, total occlusion and mural filling defect)were showed in 926 pulmonary arteries (33.9%) by MSCT and SCT. 240/384(62.5%) and 481/822(58.5%)(total 721/1206) direct manifestations were displayed respectively by MSCT and SCT in 1206 superior segmental pulmonary arteries. There was no remarkable difference between MSCT and SCT. In 1522 inferior segmental pulmonary arteries, 121/484(25.0%) and 84/1038(8.1%)(total 205/1522) direct manifestations were displayed respectively by MSCT and SCT. MSCT detected more direct manifestations than SCT did, 125 indirect signs were showed by CT plain scan.Conclusion Spiral CT pulmonary angiography is a convenient, rapid, effective and noninvasive method for diagnosing PE in the elderly. Both MSCT and SCT have high accuracy to diagnose PE in superior segmental pulmonary arteries. MSCT has the advantage in diagnosing PE in inferior segmental pulmonary arteries.