老年与非老年肺动脉栓塞双源CT肺动脉造影影像特征探讨  

Investigation imaging features of pulmonary embolism in the elderly and younger by dual-source CT pulmonary angiography

作　　者：沈璐[1] 查期 赵江民[1,3] 林翌[1] 

机构地区：[1]上海同济大学附属东方医院医学影像科,200120 [2]上海国际旅行保健中心 [3]上海市交通大学附属第三人民医院医学影像科

出　　处：《中华临床医师杂志（电子版）》2012年第21期6728-6732,共5页Chinese Journal of Clinicians(Electronic Edition)

基　　金：上海市科委科技创新行动计划重点项目(10411953400);上海市科委登山行动计划重点项目(034119931)

摘　　要：目的分析老年人和非老年人肺动脉栓塞(PE)在双源CT肺动脉造影(DECTPA)上的解剖分布特点及相关影像表现,提高亚段级PE诊断的准确性。方法回顾分析老年(≥60岁)与非老年(<60岁)PE患者各32例,所有患者行DECTPA检查,以横断面图像结合多平面重建(MPR)、容积再现(VR)、最大密度投影(MIP)等多种三维图像后处理技术,分析DECTPA图像及PE栓子形态、解剖分布。结果 (1)PE解剖分布特点:老年组PE与非老年PE组分布相似。老年组孤立性肺亚段PE(ISSPE)发生率高于非老年组(χ2=5.85,P<0.05)。(2)CTPA直接征象:1级肺动脉两组均未见栓塞病例;2级肺动脉PE分布类型组间差异无统计学意义(χ2=1.016、1.275、0.002,P>0.05);3级肺动脉PE分布以偏心型充盈缺损为主,组间差异具有统计学意义(χ2=4.323,P<0.05);4～5级肺动脉三型PE征象所占比例各不相同,组间差异均具有统计学意义(χ2=5.429、8.162、5.342、3.785、8.624、6.852,P<0.05)。间接征象:肺动脉高压、胸腔积液发生率老年组高于非老年组(χ2=7.819,P<0.05;χ2=4.267,P<0.05);非老年组以支气管动脉扩张征最常见。(3)DECTPA图像后处理技术:段、亚段级肺动脉显示率上,MPR优于MIP、VR,差异具有统计学意义(χ2=14.120、27.974、2.902、9.111、49.049、17.963,P<0.05)。结论 PE解剖分布上老年与非老年患者相似,但老年组患者ISSPE的发生率要高于非老年组患者。老年PE分布类型以偏心型充盈缺损为主。Objective To compare the anatomic distribution and imaging feature of pulmonary embolism in elderly(≥60 years old)and younger patients(<60 years old)with DECT pulmonary angiography,increase the defection of pulmonary embolism and to therefore improving the diagnostic accuracy of the subsegmental pulmonary embolism in elders.Methods We used our hospital information system to retrospectively identify 32 consecutive elderly patients and 32 younger patients who underwent pulmonary CTPA.Multiple three-dimensional reconstruction techniques such as MPR,MIP,VR were used to display the pulmonary artery and the embolism in all patients.Results(1)Anatomic distribution:there were the common anatomic distributions of PE between younger groups and elderly groups.The frequency of ISSPE in elders were more common than in younger patients(χ2=9.143,P<0.05).(2)Imaging feature:There was no pulmonary embolism at first level pulmonary artery in each group,and no statistically significant difference at second level pulmonary artery(χ2=1.016,1.275,0.002,P>0.05).Eccentric fillings defect showed statistically significant difference at third level pulmonary artery(χ2=4.323,P<0.05).Three kinds of filling defect occupy different proportion at fourth to fifth level pulmonary artery.There were statistically significance difference between the groups(χ2=5.429,8.162,5.342,3.785,8.624,6.852,P<0.05).Nondirective signs as pulmonary hypertension and pleural effusion were less frequent in younger patients(χ2=4.267,7.819,P<0.05)whereas bronchial artery dilation occurred more often in the younger groups(χ2=4.267,P<0.05).(3)Three-dimensional reconstruction techniques with DECT:In the ratio of displaying segmental and subsegmental artery,MPR was the best among MIP,VR and MPR,and there were statistically significant difference(χ2=14.120,27.974,2.902,9.111,49.049,17.963,P<0.05).Conclusions There are common anatomic distribution in two groups,but the incidence of ISSPE in elderly group is significant higher than in younger group with DECT pulmonary

关 键 词：老年人 肺栓塞 血管造影术 体层摄影术 X线计算机 亚段血管 

分 类 号：R563.5[医药卫生—呼吸系统]