X线平片CT平扫及CT肺血管造影诊断肺栓塞的临床分析  

Clinical analysis of x-ray,routine CT and CT pulmonary angiography in diagnosis of pulmonary embolism

作　　者：刘立卷 芦运生[2] 雷志丹[2] 

机构地区：[1]沁阳市人民医院CT室,河南沁阳454550 [2]河南省人民医院,郑州450003

出　　处：《医药论坛杂志》2011年第13期78-80,共3页Journal of Medical Forum

摘　　要：目的分析肺栓塞的X线平片、CT平扫及CT肺血管造影(CT pulmonary angiography,CTPA)表现,探讨三者在PE中的诊断价值。方法对经临床综合诊断的480例PE的临床及影像资料进行回顾性分析,着重探讨PE的X线平片、CT平扫及CT肺血管造影表现及临床应用价值。结果 480例PE中,65例X线有轻微异常,表现为肺浸润影、少量胸腔积液、肺不张、心脏增大、肺动脉高压;215例CT平扫可见异常,表现为栓塞区的肺血流的低灌注、肺血流的不均匀灌注(马赛克灌注)以及栓塞肺动脉血管内局部直径及密度异常,栓塞较严重者可见肺体积的减小、右心影增大、肺动脉高压、腔静脉增粗;480例CTPA均显示异常,表现为栓塞肺动脉的充盈缺损、栓塞远端肺动脉变细、肺血流的低灌注及不均匀灌注、侧枝循环形成以及近心端肺动脉高压、心影增大。结论肺栓塞的X线平片、CT平扫及CT肺血管造影均可出现异常表现,在三种影像诊断方法中以CTPA最为确切,X线平片及CT平扫出现异常几率较小且其征象无明确的特异性,但一旦出现这些征象可提示疑诊,为进一步进行CTPA检查提供参考。Objective To analyze the image manifestation of x-ray,routine CT and CT pulmonary angiography,and discuss the diagnosis value of them.Methods The clicinal and image materials of 480 cases with PE proved by clicinal integrated diagnosis were studied.Image manifestation and clinical application diagnosis value of x-ray,routine CT and CT pulmonary angiography were focused.Results There was little abnormality of x-ray in 65 cases,including lung infiltrated shadow,bits of pleural effusion,atelectasis,heart enlarged,pulmonary hypertension.There was abnormality of routine CT in 215 cases,including blood hypoperfusion in the pulmonary embolism area,pulmonary blood non-uniform perfusion（Mosaic perfusion）,pulmonary vascular abnormalities in local diameter and density,pulmonary volume became smaller in serious pulmonary embolism,right side of heart enlarged,pulmonary hypertension and vena cava thickened.480 cases appeared as abnormality in CTPA,including filling defect of pulmonary embolism,remote pulmonary artery with embolization attenuated,hypoperfusion and uneven infusion of pulmonary blood,formation of collateral circulation,pulmonary hypertension near heart,the shape of heart enlarged.Conclusions X-ray,routine CT and CTPA of pulmonary embolism all could appear abnormality,but CTPA was the most exact diagnostic method in those three kinds,the rate of abnormality in X-ray and routine CT was low,with no specificity,but CTPA was necessary when there were abnormality in X-ray and routine CT image,X-ray and routine CT could be considered as reference image.

关 键 词：肺栓塞 体层摄影术 X线计算机 血管造影术 对比研究 

分 类 号：R816.4[医药卫生—放射医学]