多层螺旋CT对肺栓塞影像表现及与其严重性关系的评价  

Imaging Findings and Severity in Pulmonary Embolism:Evaluation Using Multi-Detector Row CT

作　　者：赵艳娥[1] 朱斌[2] 张龙江[1] 陈英鑫[2] 罗松[1] 周长圣[1] 卢光明[1] 

机构地区：[1]南京军区南京总医院医学影像科,210001 [2]南京大学医学院附属鼓楼医院放射科,210008

出　　处：《临床放射学杂志》2009年第12期1627-1630,共4页Journal of Clinical Radiology

摘　　要：目的评价多层螺旋CT肺栓塞影像表现及与其严重性的关系。资料与方法回顾性分析104例临床诊断肺栓塞患者的临床及影像学资料,测量心血管参数:主肺动脉直径、右心室短轴最大径(RVMSA)、左心室短轴最大径(LVMSA)及RVMSA/LVMSA比值,计算CT肺动脉成像(CTPA)阻塞指数,评价CTPA上栓子的形态和与双能量CT(DECT)上灌注缺损的关系及CTPA阻塞指数与心血管测量参数的关系。结果104例中,32例因图像丢失(n=10)、CTPA图像欠佳,不满足测量要求(n=9)或未行CTPA检查(n=13),故只对72例患者的影像学资料进行分析评价。完全闭塞型肺栓塞DECT表现为整个肺叶灌注降低或某个肺段灌注缺损,部分闭塞型DECT表现为灌注降低或正常。CT阻塞指数与心血管测量参数具有一定的相关性(P<0.05),以CT阻塞指数与RVMSA/LVMSA比值相关性最高(r=0.519,P<0.001)。结论肺灌注异常与否取决于肺动脉栓塞的程度;CT肺动脉阻塞指数可用于评价肺栓塞的严重性。Objective To evaluate imaging findings and severity in pulmonary embolism （PE） using multi-detector row CT. Materials and Methods One hundred and four PE patients were included in this study. Their clinical and CT data were retrospectively analyzed. The correlation between the morphology of clots on CT pulmonary angiography （CTPA） and perfusion findings on the dual energy CT （DECT） was evaluated. Right ventricular （RVMSA） maximal short axis,left ventricular （LVMSA） maximal short axis ratio,pulmonary artery diameter and the ratio of RVMSA maximal short axis to LVMSA maximal short axis （RVMSA/LVMSA） were measured and calculated. The correlation between above-mentioned protocols and CT obstruction index was analyzed. Results 32 cases were excluded because of image missing（ n = 10） ,bad image （n = 9） and 21o CT exams （n = 13 ） , and CT image of 72 cases were analysis. Corresponding perfusion defects were present in the areas of puhnonary arteries with obstructive clots, whereas decreased peffusion impairment or normal perfusion were noted for the areas of puhnonary arteries with nonobstructive clots. The CT obstruction index correlated with cardiovascular measuremeuts （all P 〈 0.05 ）, RVMSA/LVMSA ratio having the highest correlation coefficient（ r =0. 519, P 〈 0. 001 ）. Conclu-sion Lung peffusion impairment depends on the obstructive degree of pulmonary arteries. CT obstruction index can be used to evaluate the severity of PE.

关 键 词：阻塞指数 肺栓塞 体层摄影术 X线计算机 肺灌注 

分 类 号：R563.5[医药卫生—呼吸系统] R816.4[医药卫生—内科学]