双源CT对肺动静脉瘘的诊断研究

目的:探讨双源CT肺动脉血管成像对肺动静脉瘘的诊断价值.方法:回顾性搜集86例临床疑诊肺动静脉瘘行双源CT肺动脉血管成像的病例,所有病例均有肺动脉DSA造影对照,肺动脉DSA造影为参考标准,将CT诊断结果与DSA结果对照.结果:双源CT肺动脉成像诊断肺动静脉瘘49例,其中囊型43例(单纯囊型12例,复杂囊型31例),弥漫型6例.DSA诊断肺动静脉瘘53例其中囊型43例(单纯囊型12例,复杂囊型31例),弥漫型10例,双源CT肺动脉成像诊断肺动脉瘘准确度95.3％,敏感度为92.3％,特异度为100％,阳性预测值100％,阴性预测值89.2％.发现弥漫型PAV F受累肺叶磨玻璃病灶内同时包含增粗的小肺动脉及小肺静脉两种血管.结论:双源CT诊断PAVF与DSA对比具有较高的准确性,其中CT诊断囊型PAVF与DSA完全一致,综合运用VR、MIP、MPR可形象展示囊型PAVF的个数、供血肺动脉及引流肺静脉的情况.弥漫型PAVF应注重寻找有无与小肺动脉及小肺静脉相连的胸膜下结节及有无同时包含增粗的小肺动脉及小肺静脉的磨玻璃影,以避免错诊、漏诊.

Dual source CT in the diagnosis of pulmonary arteriovenous fistula

Objective:To explore the value of dual source CT pulmonary angiography in diagnosis of pulmonary arteriovenous fistula (PAVF).Methods:We retrospectively collected 86 patients with suspected pulmonary arteriovenous fistula undergone dual source CT pulmonary angiography,all cases had pulmonary DSA as the reference standard,the results of CT diagnosis were compared with DSA.Results:Dual source CT pulmonary angiography diagnosed pulmonary arteriovenous fistula in 49 cases,including 43 cases of cystic type (12 cases of simple cystic type,31 cases of complex cystic type),and 6 cases of diffuse type.Dual source CT imaging in the diagnosis of pulmonary artery arteriovenous fistula had an accuracy of 95.3％,sensitivity of 92.3％,specificity of 100％,positive predictive value of 100％,and negative predictive value of 89.2％.We found that there were dilated small pulmonary artery and pulmonary vein in the ground glass opacities of diffuse type of PAVF.Conclusion:The diagnosis of PAVF using dual source CT has high accuracy compared with DSA,among them,CT diagnosis of cystic PAVF was completely consistent with DSA.VR,MIP,MPR can be used to display the number of cystic PAVF,pulmonary artery and pulmonary vein drainage,to provide help for clinical treatment.In diffuse type PAVF one should pay attention to the search for the presence or absence of small pulmonary artery and small pulmonary veins connected to the pleural nodules and whether or not containing both the dilated small pulmonary artery and small pulmonary vein in the ground glass opacity,in order to avoid misdiagnosis and missed diagnosis.