多排螺旋CT肺血管成像结合血浆D-二聚体测定对肺动脉栓塞的诊断价值

目的探讨多排螺旋CT肺血管成像(MSCTPA)结合血浆D-二聚体(D-dimer,DD)测定在肺动脉栓塞(pulmonaryem-bolism,PE)诊断中的应用价值方法对48例临床可疑PE患者进行MSCTPA检查和血浆DD检测以临床诊断为依据,分别评价MSCTPA、DD测定及MSCTPA结合血浆DD测定对PE的诊断价值其中22例病人于MSCTPA检查结果阳性后即进行溶栓治疗,并于治疗后第2天、第3天、第7天及2周分别复查DD值,于治疗后2周内分别复查了1次MSCTPA结果DD测定值全部阳性(48例),阳性率100%;MSCTPA共检出PE45例,3例无明显栓塞征象(2例肺内见片状炎性浸润影,1例两肺见散在纤维束条影),45例PE中1例MSCTPA首诊结果可疑,在DD阳性的提示下行0.625mm薄层重建肯定了PE的诊断溶栓治疗后复查的22例中,13例于1周内DD测定值升高,1周后DD测定值下降,9例DD值变化不明显;MSCTPA复查中DD值先升高后下降的13例充盈缺损征象明显改善,9例DD值变化不明显者充盈缺损征象亦无明显变化结论MSCTPA和血浆DD测定结合可提高PE的检出率,对诊断PE具有重要的临床应用价值

Diagnostic Value of Pulmonary Embolism of Multi-slice Spiral CT Pulmonary Angiography in Combination with Plasma D-dimer Assay

Objective To investigate the diagnostic assessment of multi-slice spiral CT pulmonary angiography(MSCTPA)in combination with plasma D-dimer assay in the diagnosis of pulmonary embolism.Methods 48 cases suspected pulmonary embolism underwent both MSCTPA and plasma D-dimer assay ,the diagnostic values of MSCTPA,the plasma D-dimer assay and the combination of MSCTPA and the plasma D-dimer assay were evaluated respectively. 22 patients of them underwent thrombolytic treatment after positive MSCTPA,and plasma D-dimer assays 2 nd day,3 rd day,7 th day and fortnight after treatment were performed respectively,MSCTPA was done again two weeks after treatment.Results The plasma D-dimer assays were all positive(48 cases),the positive rate was 100%; 45 patients were interpreted as PE by MSCTPA ,and 3 patients without apparent filling defect expression. One suspicious PE patient was confirmed by later thinner-slice reconstruction of 0.625 mm on account of positive D-dimer assay. Among 22 patients reexaminated by D-dimer assay,the values of D-dimer assay in 13 patients increased within one week and decreased one week later,while the other 9 patients revealed no evident change.The area of filling defect of the former 13 patients became smaller,the latter 9 patients without obvious change on reexamniation of MSCTPA.Conclusion The combination of MSCTPA and plasma D-dimer assay can enhance the detecting rate of PE,and has significant value in diagnosing pulmonary embolism.