CT肺动脉和肾静脉联合成像扫描时相的选择及在肾病综合征患者血栓检测中的应用  

Optimization of combined CT pulmonary angiography and renal venography for the detection of venous thromboembolism in patients with nephrotic syndrome

作　　者：郑玲[1] 吴新生[1] 周长圣[1] 祁丽[1] 张龙江[1] 卢光明[1] 

机构地区：[1]南京军区南京总医院医学影像科,210002

出　　处：《中华放射学杂志》2013年第12期1124-1127,共4页Chinese Journal of Radiology

摘　　要：目的 优选合理的CT肺动脉（CTPA）和肾静脉（rCTV）联合成像技术参数并评价其在肾病综合征患者静脉血栓检出中的价值.方法 选择临床诊断的90例肾病综合征患者纳入前瞻性研究.前45例为第1组,完成CTPA扫描后延迟25 s行肾静脉期扫描,再延迟25 s行下腔静脉期扫描（参数1）;后45例患者为第2组,完成CTPA扫描后延迟50 s行下腔静脉期扫描（参数2）,第2组3例患者因无肺动脉或肾静脉CT数据未纳入研究.采用独立样本t检验比较2种参数下的肺动脉强化值、肾静脉强化值以及辐射剂量;采用x2检验比较2组血栓检出率的差异.结果 第1组和第2组肺动脉干的CT值分别为（335.5± 111.3）和（335.0 ±76.0） HU,右肾静脉CT值分别为（142.7±33.3）和（140.7 ±25.9） HU,左肾静脉CT值分别为（141.6 ±26.4）和（138.8±33.6） HU,差异均无统计学意义（t值分别为0.026、0.322和0.452,P值均＞0.05）.第1组的容积CT剂量指数和剂量长度乘积分别为（19.7 ±4.3）mGy和（1019.9 ±878.5）mGy·cm,第2组分别为（13.6 ±3.0）mGy和（532.0±132.9）mGy·cm,差异均有统计学意义（t值分别为7.756和3.684,P值均＜0.01）.87例中,CTPA和rCTV联合成像共检出44例（50.6％）有静脉血栓,其中肺栓塞19例、肾静脉血栓合并肺栓塞17例、肾静脉血栓7例、下腔静脉血栓1例.利用参数1和参数2各检出22例静脉血栓患者,检出率分别为48.9％（22/45）和52.4％（22/42）,差异无统计学意义（x2=0.106,P=0.745）.结论 应用CTPA扫描后延迟50 s行下腔静脉期扫描的CTPA和rCTV联合成像更适合用于临床应用.肺栓塞是NS患者最常见的血栓并发症.Objective To optimize combined CT pulmonary angiography （CTPA） and renal venography （rCTV） and to evaluate its value for the detection of venous thromboembolism in patients with nephrotic syndrome （NS）.Methods Ninety NS patients suspected of venous thromboembolism because of abnormal D-dimer value were included in this prospective study.The first 45 patients were defined as group 1 （protocol 1）.These patients underwent CTPA,then rCTV 25 s after CTPA,last inferior vena cava scanning after another 25 s.The following 45 patients as group 2 （protocol 2）.These patients underwent CTPA and then inferior vena cava scanning 50 s after CTPA,3 patients in group 2 were excluded because of unavailable CTPA or rCTV.Vessel enhancement of CTPA and rCTV,and radiation doses for two protocols were compared with independent sample student t test.Incidence and distribution of pulmonary embolism and renal vein thrombosis were recorded and compared by using Chi-square test.Results Enhancement values of pulmonary trunk for groups 1 and 2 were （335.5 ± 111.3） and （335.0 ± 76.0） HU,right renal vein were （142.7 ±33.3） and （140.7 ±25.9） HU,left renal vein were （141.6 ±26.4） and （138.8 ±33.6） HU respectively,without any statistical difference （t values were 0.026,0.322 and 0.452,P 〉0.05）.Radiation dose to the patients receiving protocol 2 were lower than that of patients receiving protocol 1 [volume CT index,（19.7 ± 4.3） vs （13.6 ± 3.0） mGy; dose length product,（1019.9 ± 878.5） vs （532.0 ± 132.9） mGy · cm; both P 〈0.01].Of 87 NS patients,44 venous thromboembolism events were detected,resulting in the incidence of 50.6% （44/87）,including pulmonary embolism in 19 patients,renal vein thrombosis and pulmonary embolism in 17,renal vein thrombosis in 7,and inferior vena cava in one patient.The detection rate were 48.9% （22/45） and 52.4% （22/42）,there was no significant difference （x2 =0.106,P =0.745）.Conclusion Combined CTPA and rCTV with protocol 2 （C

关 键 词：肾病综合征 静脉血栓形成 体层摄影术 X线计算机 血管造影术 

分 类 号：R816.7[医药卫生—放射医学]