多层螺旋CT三期动态增强扫描对肺栓塞病理及病理生理诊断意义  

Three-phase Dynamic Multislice Spiral CT Contrast-Enhanced Scan in the Pathologic and Pathophysiologic Diagnosis of Pulmonary Embolism

作　　者：张秀丽[1] 吕申[2] 郭冬梅[1] 于晓艳[1] 郑洪生[1] 

机构地区：[1]大连医科大学附属第二医院放射线科,辽宁大连116027 [2]大连医科大学附属第二医院病理学实验中心,辽宁大连116027

出　　处：《实用放射学杂志》2007年第1期46-50,共5页Journal of Practical Radiology

摘　　要：目的 探讨多层螺旋CT三期动态增强扫描方法诊断肺栓塞的可行性及其对肺栓塞病理及病理生理学改变的诊断意义。方法 分析20例临床疑诊肺栓塞患者CT平扫及多期动态增强扫描表现。增强扫描使用非离子型水溶性碘剂，浓度300mgI／L，总量100ml，3ml／s高压注射。其中两期增强扫描9例，延迟时间分别为20～25s和60s；三期增强扫描11例，延迟时间分别为5～15s、25～32s和60～80s。结果 三期增强扫描中，Ⅰ期（肺动脉期）延迟5～7s，可从密度上区别肺动、静脉及左右心腔；Ⅱ期（主动脉期）延迟23～25s，胸内各血管均达到最佳强化，肺动脉栓子此期显示最清晰；Ⅲ期（实质期）延迟60s，实质组织及肺门支气管周围淋巴结有强化。结论 三期增强扫描中主动脉期是主要期程，是诊断肺栓塞显示肺动脉内栓子的最好时相，肺动脉期和实质期可以起到辅助诊断肺栓塞的继发性病理及病理生理改变及鉴别诊断作用。Objective To discuss the feasibility of the multislice spiral CT three - phase dynamic contrast - enhanced （CE） scan in the diagnosis of pulmonary embolism （ PE ） and its value in the pathologic and pathophysiologic diagnosis of PE. Methods Plain CT and CE CT manifestations of 20 patients with suspected PE were analysed. The contrast medium was non - ion water soluble iodide with concentration of 300 mgI/L in CE scan. The total amount was 100 ml,and at high pressure with velocity of 3 ml/s. Results In the three - phase CE scan, when phase Ⅰ（ pulmonary phase） delayed 5 -7 s, the pulmonary arteries and veins could be differentiated in density ,and the left and right chambers could be differentiated too. When phase Ⅱ（ aortic phase） delayed 23 - 25 s, the vessels in the thorax were all best enhanced, and the pulmonary emboli were showed most clearly;When phase Ⅲ（ parenchymal phase） delayed 60s, the parenchymal tissue and lymphonodes around the pulmonary hila and bronchi had enchancement of different degree. Conclusion In three - phase CE CT scan, the aortic phase is the important phase in which pulmonary emboli can be showed most clearly and so that PE can be diagnosed. The pulmonary phase and parenchymal phase play an accessory role in which the secondary changes in pathology and pathophysiology of PE can be diagnosed , and differential diagnosis can be made.

关 键 词：肺栓塞 体层摄影术 X线计算机 动态增强扫描 

分 类 号：R563.5[医药卫生—呼吸系统] R814.42[医药卫生—内科学]