多层螺旋CT肺血管造影对肺动脉栓塞的诊断价值  

The Value of Multi-slice spiral CT Pulmonary Angiography in Diagnosing Pulmonary Embolism

作　　者：宋光义[1] 胡茂清[1] 韩丹[1] 杨亚英[1] 包颜明[1] 孙桂芳[1] 

机构地区：[1]昆明医学院第一附属医院CT室,云南昆明650032

出　　处：《实用放射学杂志》2008年第1期20-23,26,共5页Journal of Practical Radiology

摘　　要：目的探讨MSCT肺血管造影对肺栓塞的诊断价值。方法Ⅰ组25例采用2.5 mm准直,3.2 mm层厚扫描。Ⅱ组10例采用1 mm准直,1.3 mm层厚扫描。2组中5例患者在MSCTPA后行下肢深静脉扫描。结果2组对主肺动脉、叶肺动脉显示无差异,对段、亚段及5级分支显示,1 mm准直优于2.5 mm准直。MSCTPA显示受累肺动脉486支,肺动脉充盈缺损包括中心型(276支),锐角附壁型(87支),钝角附壁型(12支),完全附壁型(111支)。急性肺栓塞31例,慢性肺栓塞4例。间接征象包括肺梗死、肺少血征、马赛克征、胸腔积液、主肺动脉和/或叶肺动脉扩张、右心室增大、室间隔移位等。CTV显示双侧股静脉栓塞3例,单侧股静脉及股深静脉栓塞2例。结论多层螺旋CT肺血管造影能清楚显示肺栓塞的直接征象及间接征象,1 mm准直薄层扫描能发现更多外围肺动脉栓塞,MSCTPA与CTV联合成像有助于肺栓塞的确诊。Objective To explore the value of MSCT pulmonary angiography in diagnosis of pulmonary embolism） PE）. Methods 25 cases in group Ⅰ and 10 cases in group 11 were scanned using 2.5 mm ,1 mm collimation and 3.2,1.3 mm reconstructed thickness respectively. The lower extremity deep vein was scanned after MSCT pulmonary angiography in 5 cases respectively in two group. Results In dis- playing the central and lobal pulmonary arteries was no significant difference in two group, 1 mm collimation was superior to 2.5 mm collimation in displaying the segmental, subsegmental and fifth - order pulmonary arteries. 486 embolized pulmonary artereis were displayed by MSCTPA, the filling defect signs of pulmonary artery were classified as central type （ n = 276） , mural type with sharp angle （ n = 87 ） , mural type with obtuse angle （ n = 12 ） and completely - obstructed type（ n = 111 ）. The indirect signs included pulmonary infarction, Westermark＇ s sign, mosaic sign, pleural effusion, dilated central and/or lobal pulmonary arteries, enlargement of right ventricle and displacement of interventricular septum. Bilateral femoral vein embolism in 3 cases and single lateral femoral vein and deep femoral vein embolism in 2 cases were displayed by CTV. Conclusion The direct and indirect signs of PE can be displayed clearly by MSCT pulmonary angiography, more peripheral arterial embolism can be displayed by 1 mm collimation thin - thickness scan. MSCTPA combined with CTV scan can improve the diagnosis of PE.

关 键 词：肺 肺栓塞 体层摄影术 X线计算机 血管造影术 

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