双能量CT肺灌注在肺栓塞诊断及危险分层中的价值

  目的  探讨双能量CT肺灌注的灌注缺陷对肺栓塞诊断及危险分层。  方法  选取我院2018年1月~2020年12月157例临床疑诊为肺栓塞的患者为研究对象，最终120例患者确诊肺栓塞，所有患者均行双能量CT肺灌注成像(DEPI)及肺动脉CT血管造影成像(CTPA)，根据临床生物学标志及影像学改变，将患者分为肺栓塞低危组(n=30)、中危组(n=35)、高危组(n=55)。比较患者肺栓塞数量，肺动脉灌注缺失面积分数、右/左心室短轴最大径比值及心脏生物学标志物。所有患者随访3月并记录结局。  结果  DEPI与CTPA对肺栓塞的诊断相符，诊断符合率为86.1%; CTPA和DEPI联合诊断的曲线下面积为0.95，特异性为89.20%，敏感度为95.80%，Youden指数为0.85，较CTPA和DEPI单独诊断肺栓塞更好。肺栓塞低危组、中危组、高危组的灌注缺损面积、心脏生物学标志物及右/左心室短轴最大径比值经两两比较差异有统计学意义(P < 0.05)。  结论  DEPI可作为CTPA的诊断肺栓塞的补充，并通过肺动脉灌注缺失面积分数危险分层，是一种新的临床诊疗方案的选择。 

Diagnosis and risk stratification of pulmonary embolism by dual-energy CT perfusion

  Objective  To investigate the role of perfusion defects in dual-energy CT pulmonary perfusion in the diagnosis and risk stratification of pulmonary embolism.  Methods  A total of 157 patients diagnosed with suspected pulmonary embolism in our hospital from January 2018 to December 2020 were enrolled, and pulmonary embolism was finally confirmed in 120 patients. All patients were performed with dual- energy CT pulmonary perfusion imaging (DEPI) and pulmonary artery CT angiography (CTPA). The number of pulmonary embolisms, pulmonary artery loss area fraction, right/left ventricular short-axis maximum diameter ratio and cardiac biological markers were recorded and compared. All patients were followed up for 3 months with the outcomes recorded.  Results  Dual-energy CT was consistent with CTPA in the diagnosis of pulmonary embolism, with a diagnostic coincidence rate of 86.1%. For CTPA combined with DEPI, AUC value was 0.95, with the specificity, sensitivity, and Youden index of 89.20%, 95.80% and 0.85, respectively, better than CTPA and DEPI alone in the diagnosis of pulmonary embolism. There were significant differences in perfusion defect area, cardiac biological markers, and right/left ventricular short- axis maximum diameter ratio levels between the low-risk, medium-risk, and high- risk groups of pulmonary embolism (P < 0.05).  Conclusion  DEPI can be used as a supplement for the diagnosis of pulmonary embolism by CTPA. Through risk stratification for pulmonary artery perfusion loss area fraction, it is a new option for clinical diagnosis and treatment, suitable for clinical promotion.