64排螺旋CT血管造影对肺动脉栓塞的诊断价值

目的评价64排螺旋CT肺动脉血管造影（CT pulmonary angiography，CTPA）对肺动脉栓塞（pulmonary embolism，PE）的诊断价值。方法对临床疑诊急性肺动脉栓塞的72例患者行CTPA检查，并行多平面重建（MPR），最大密度投影（MIP）及容积重建技术（VR）。结果72例共累及476处肺动脉及分支，其中右肺动脉主干36处，左肺动脉主干42处，肺叶动脉157处，肺段动脉203处，亚段动脉38处，CTPA征象分为直接和间接征象，直接征象：肺动脉主干或分支内混合性、附壁性、中心性充盈缺损。间接征象：局限性肺纹理稀疏，肺动脉高压，右心室增大，胸腔积液等。结论64排CTPA具有准确、快速、无创伤等优点，可立体、直观地观察到肺动脉血栓的大小、分布及范围并可观察肺内间接改变，是临床诊断及观察疗效的首选方法。

The value of 64 multi-detector helical CT angiography in diagnosis of pulmonary embolism

Objective： To evaluate the value of 64 multi-detector helical computer tomography pulmonary angiography （CTPA） in the diagnosis of pulmonary embolism （PE）. Methods： Seventy -two patients clinically suspected of PE underwent 64 multi-detector CTPA. MPR, MIP and VR were performed simultaneously. Results： The embolisms were found to be involved in 476 branches of the pulmonary arteries in all 72 cases with PE, including involved right main pulmonary artery 36 branches, left main pulmonary artery 42 branches, lobular pulmonary artery 157 branches, segmental pulmonary artery 203 branches and subsegmental pulmonary artery 38 branches. The CT features of PE cases included the direct signs ： mixed filling defect, mural filling defect, central filling defect; and the indirect signs： local oligemia, pulmonary hypertension, enlargement of right ventricle, and pleural effusion, etl. Conclusion ： Sixty - four multi-detector CTPA is an accurate, quick and noninvasive method in the diagnosis of PE, which can be used widely. It can help us to observe the size, distribution and area of the embolism. In a word, it is an optimal method for the clinical diagnosis and observation.