肺动脉CT造影检查对肺动脉肉瘤鉴别诊断的意义  

The differential diagnostic value of pulmonary CT angiogram on pulmonary artery sarcoma

作　　者：甘辉立[1,2] 张健群[1,2] 黄小勇[1,3] 冯磊[1,2] 孙建超[1,2] 赵映[1,4] 朱光发[1,5] 陈东[1,6] 

机构地区：[1]首都医科大学附属北京安贞医院 [2]北京心肺血管疾病研究所心脏外科中心,100029 [3]北京心肺血管疾病研究所医学影像科,100029 [4]北京心肺血管疾病研究所超声心动图科,100029 [5]北京心肺血管疾病研究所呼吸内科,100029 [6]北京心肺血管疾病研究所病理科,100029

出　　处：《心肺血管病杂志》2015年第6期480-485,共6页Journal of Cardiovascular and Pulmonary Diseases

基　　金：国家自然科学基金(81070041);北京市卫生系统高层次卫生人才队伍建设专项经费(学科带头人)(2013-2-02);北京市科技计划项目(Z121107001012067)

摘　　要：目的:比较分析各种诊断方法对肺动脉肉瘤(pulmonary artery sarcoma,PAS)的诊断正确率,以探讨提高肺动脉肉瘤的诊断正确率的方法。方法:回顾性分析2001年11月至2014年1月,安贞医院收治19例肺动脉肉瘤的CT平扫、超声心动图、胸部X线平片、心电图、通气灌注扫描及肺动脉CT造影(PACTA)对肺动脉肉瘤的诊断正确率和特点。结果:14例手术后病理学检查证实为肺动脉肉瘤;5例未行手术治疗者,正电子发射断层显像(PET-CT)检查显示为:氟脱氧葡萄糖摄取异常增高团块影。19例患者的PACTA均显示蚀壁征;对于前12例PAS,因为不认识肺动脉CTA"蚀壁征"而导致全部术前误诊;而后7例,因为发现PACTA"蚀壁征"均诊断正确。PACTA"蚀壁征"诊断正确率高于CT平扫、超声心动图、胸部X线平片、心电图及通气灌注扫描。结论:CT平扫、超声心动图、胸部平片、心电图及通气灌注扫描对肺动脉肉瘤的诊断均无特异性,均对PAS的鉴别诊断价值不大,而在PACTA中的"蚀壁征"征象具有肺动脉肉瘤疾病特征性,有助于肺动脉肉瘤与肺动脉栓塞性疾病的早期鉴别诊断。Objective： Our aim was to characterize the differential diagnostic characteristics of pulmona- ry artery sarcoma （PAS） through various diagnostic modes, in order to promote the diagnostic efficiency to pul- monary artery sarcoma. Methods： from November, 2001 to January, 2014, nineteen PAS were diagnosed, and 14 of them were surgically treated at Beijing Anzhen Hospital, and the data were retrospectively reviewed. Re- suits： 14 patients were confirmed pulmonary artery sarcoma through histo-pathological investigation after surger- y; the other five patients were confirmed to have FDG abnormal high intake mass shadow in PET-CT scan. All 19 patients underwent pulmonary artery CTA scan, and all showed a filling defect within the lumen of the pul- monary artery with a sign of wall eclipsing on pulmonary artery CTA; For the first 12 cases of PAS, because we did not known the ＂eclipse wall sign＂ on pulmonary artery CTA, thus leading to a misdiagnosis; then for the other seven cases afterward, we found ＂wall eclipse sign＂ on pulmonary artery CTA, thus reaching a correct di- agnosis. Pulmonary artery CTA with ＂eclipse wall sign＂ has a higher diagnostic accuracy than CT scan, echo- cardiography, chest radiography, ECG, ventilation perfusion scan, the difference among them reached statisti- cally significance （t test, P = 0. 0001 ）. Conclusion： CT scan, echocardiography, chest radiography, ECG,ventilation-perfusion scan is nonspecific to the diagnosis of pulmonary artery sarcoma, thus they are of little di- agnostic value to the lesion. The wall eclipsing sign on pulmonary artery CTA is pathognomonic for PAS; pa- tients with this sign should be investigated to confirm the diagnosis and should undergo surgical intervention as soon as possible, rather than receiving thrombolytic or anticoagulant therapy.

关 键 词：肺动脉肉瘤 肺动脉CT造影 血管成像 蚀壁征 

分 类 号：R56[医药卫生—呼吸系统]