非肺栓塞灌注缺损的双能量CT肺灌注成像表现及病因分析  

The manifestations and causes of pulmonary perfusion defects on double energy CT in patients with no pulmonary embolism

作　　者：马延贺[1] 张洪[1] 杨雅朋 张悦东[1] 徐乃勋[1] 

机构地区：[1]天津市胸科医院放射科,天津300222

出　　处：《放射学实践》2015年第3期240-244,共5页Radiologic Practice

基　　金：天津市卫生局自然科学基金资助项目(2012KZ055)

摘　　要：目的:分析无肺栓塞双能量CT(DECT)肺灌注图像中灌注缺损的特征及其原因。方法:搜集行DECT肺灌注扫描而无肺栓塞的60例受检者的影像学资料。由两位影像科医生分析灌注缺损的原因,如线束硬化伪影、运动伪影、肺内实质病变、气肿、气体潴留等,记录灌注缺损数和占各肺段的比例;统计灌注缺损的形状、大小、边缘及原因。分析各种原因引起的灌注缺损的影像特征。结果:60例无肺栓塞受检者DECT肺灌注图像上共345个肺段发现灌注缺损,其原因为:线束硬化伪影(170个肺段)、心脏或膈肌运动伪影(140个肺段)及肺内病变等(35个肺段)。线束硬化伪影引起的灌注缺损主要分布在双肺上叶尖段和前段,多呈条带状灌注缺损;心脏运动伪影引起的灌注缺损主要位于右肺中叶内侧段和左肺舌叶上段,多呈新月形灌注缺损。结论:认识非肺栓塞引起的灌注缺损的影像特征有助于提高DECT肺灌注成像诊断肺栓塞的准确性。Objective：To analyze the features and the causes of perfusion defects on dual energy CT（DECT）pulmonary perfusion images in patients without pulmonary embolism.Methods：The imaging materials of 60 patients without pulmonary embolism underwent DECT pulmonary perfusion scanning were recruited.The causes of perfusion defect such as beam hardening artifact,motion artifacts,pulmonary parenchymal disease,emphysema,gas retention etc.were analyzed by 2radiologists,the number of lung perfusion defects and the proportion accounted for the pulmonary segments were recorded.The shape,size,margin,and causes of perfusion defects were counted and the imaging characteristics of various causes of perfusion defects were analyzed.Results：Totally,there were 345 pulmonary segments showing perfusion defects in these 60 patients without pulmonary embolism.The causes included beam hardening artifacts（170pulmonary segments）,artifacts caused by heart beat or diaphragmatic movement（140pulmonary segments）and intra-pulmonary lesions（35pulmonary segments）.Perfusion defect caused by beam hardening artifacts were mainly distributed in the apical and anterior segments of bilateral upper lobes,mostly showed as multi-stripe perfusion defects.Perfusion defects caused by cardiac motion artifacts were mainly located in the medial segment of the right middle lobe and upper segment of left lingular lobe,mostly showed as crescent shaped perfusion defects.Conclusion：Understanding of the features and causes of pulmonary perfusion defects in patients with no pulmonary embolism can improve the diagnosis accuracy of pulmonary embolism on DECT lung perfusion imaging.

关 键 词：肺栓塞 体层摄影技术 X线计算机 血管造影术 肺灌注成像 

分 类 号：R816.41[医药卫生—放射医学]