双能量CT肺动脉联合间接下肢静脉造影对静脉栓塞症诊断的临床研究  

The clinical application of combined dual-energy CT pulmonary angiography and indirect venography

作　　者：富青[1] 刘永华[1] 雷子乔[1] 余建明[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院放射科,武汉430022

出　　处：《中华放射学杂志》2013年第1期39-43,共5页Chinese Journal of Radiology

基　　金：2011年湖北省自然科学基金计划资助项目（2011CBD110）

摘　　要：目的探讨双能量cT肺动脉成像（DE-CTPA）联合间接下肢静脉造影（CTV）在诊断静脉栓塞症（VTE）中的临床应用价值。方法对49例下肢水肿且临床怀疑肺动脉栓塞（PE）患者行DE-CTPA联合CTV检查。所有患者于CT检查前1～2d均已行下肢深静脉超声（US）检查。由2名放射专家分别对DE-CTPA和DEPI进行5级评分，并行Kappa一致性分析，同时对CTV和uS诊断下肢深静脉血栓形成（DVT）的结果行配对卡方检验。结果49例患者中PE、DVT共存21例，DE-CTPA检出PE29例，其中CTPA检出28例，DEPI多检出1例，二者均显示PE19例，均未显示PE18例。DEPI与CTPA在诊断PE方面存在较好的一致性（Kappa=0．7534）。US检出DVT38例，CTV检出35例并显示盆腔静脉受累25例，下腔静脉受累3例。CTV与US在诊断DVT上差异无统计学意义（P=0．625）。对于VTE的检出率DE．CTPA联合CTV扫描模式较单独CTPA高30．6％（15／49）。结论DE-CTPA联合CTV扫描模式，可以对PE和DVT同时进行评估，提高VTE的诊断检出率，还可以通过肺灌注成像了解PE后的血流动力学改变，实现＂一站式＂检查。Objective To assess the usefulness of combined dual-energy CT pulmonary angiography （DE-CTPA） and indirect CT venography （CTV） in the diagnosis of venous thromboembolism （ VTE ）. Methods Forty-nine patients with leg swelling suspected of pulmonary embolism （PE） underwent both DE-CTPA combined with CTV and lower extremity venous ultrasound （US） in 1--2 days prior to CT. Image quality of CTPA and dual energy lung perfusion image （DEPI） was rated using a 5-point scale and the coherence between CTPA and DEPI was analyzed by Kappa statistics. The ability of CTV and US in the diagnosis of deep venous thrombosis （DVT）was compared by Chi-square test. Results Twenty-nine of 49 patients were identified with PE by DE-CTPA,including 28 patients identified by CTPA and one more by DEPI, and 21 patients were found to have both PE and DVT. Both DE-CTPA and DEPI had positive findings for pulmonary embolism in 19 patients and both had negative findings in 18 patients. There was a moderate agreement between DEPI and DE-CTPA in the assessment of PE （ Kappa value = 0. 7534 ）. Thirty-eight patients with DVT were identified by US, while 35 patients were identified by CTV. Among the 35 patients with DVT identified by CTV, pelvic veins were involved in 25 patients, while the inferior vena cava was involved in 3 patients. There was no significant difference between CTV and US in the diagnosis of DVT（ P = 0. 625）. The detection rate of VTE with DE-CTPA combining CTV was 30. 6% higher than that with CTPA alone. Conclusions The combined DE-CTPA and CTV achieves ＂ one-stop＂ examination. It not only provides evaluation of PE and DVT and increases detection of VTE, but also depicts perfusion defect of pulmonary parenchyma that corresponds to PE.

关 键 词：肺栓塞 静脉血栓形成 静脉造影术 体层摄影术 x线计算机 

分 类 号：R816.2[医药卫生—放射医学]