320排CT肺血管减影成像对急性肺栓塞诊断的初步临床研究  

Preliminary Study on 320-Row CT Digital Subtraction Pulmonary Angiography in Acute Pulmonary Embolism

作　　者：朱乐[1] 雷子乔[1] 余建明[1] 杨明[1] 罗雄[1] 蔡晓明[1] 王勇[1] 梁斌[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：《临床放射学杂志》2017年第5期728-732,共5页Journal of Clinical Radiology

基　　金：湖北省自然科学基金资助项目(编号:2014CFB986)

摘　　要：目的探讨320排CT肺血管减影成像(DSCTPA)在肺栓塞(PE)诊断中的价值。方法 79例临床怀疑PE患者行DSCTPA,先进行CT平扫,后立即行CT肺动脉血管造影(CTPA),并将两组图像加载到Sure-Subtraction Lung软件进行处理,得到两组视图模式图像:Tissue模式为碘分布图融合肺动脉血管像(CTPA+碘图),Vessels模式为减影后肺动脉血管图像(CTPA+血管像)。由2名医师采用双盲法对2组图像和CTPA图像进行分析,肺动脉血管按肺动脉干,叶、段、亚段及以下,分别记录各患者栓子的数目与位置。研究图像显示方法诊断PE的敏感度、特异度、假阴性率及假阳性率。结果每个病例减影后处理平均耗时3.5 min,按标准测得血栓共326个,其中位于主干35个,叶肺动脉76个、段肺动脉133个、亚段及以下82个。CTPA图像、CTPA+血管像以及CTPA+碘图3组显示PE总栓子数的灵敏度、特异度及假阴性率和假阳性率分别为87.7%/91.7%/96.6%、82.9%/85.2%/83.7%、12.3%/8.3%/3.4%和17.1%/14.8%/16.3%。CTPA、CTPA+血管像、CTPA+碘分布图三种方法在各肺段栓子检出率为肺叶动脉96.1%/97.4%/98.7%,肺段动脉85.7%/92.5%/97.0%和肺亚段动脉及以下76.8%/81.7%/92.7%。结论DSCTPA成像一次减影可同时得到2组模式图像,有助于提高对周围肺动脉的显示能力和反映碘剂在肺实质的分布。CTPA图像结合碘分布图和血管减影图,不仅提高了亚段及以下段PE栓子的诊断检出率,而且可评价肺动脉栓塞后肺实质血流灌注的变化,为制定临床治疗方案提供参考。Objective Our preliminary study was to evaluate a new subtraction technique for CT pulmonary angiography with Toshiba 320-row CT, and its iodine distribution maps and subtraction vessel maps in the diagnosis of intrapulmonary clots （IPC） in acute pulmonary embolism （PE）. Methods Seventy-eight patients who were suspected to have pulmonary embolism underwent Digital Subtraction CT pulmonary angiography （DSCTPA） with a new technique of 320-row CT. Noncontrast CT scan was performed then followed by CTPA. These two series of images were processed using the sure-Subtraction Lung software, and two types of Subtraction images were generated： tissue mode for iodine distribution maps fusion of CTPA image （ CTPA ＋ iodine map） and vessel mode for the subtraction pulmonary vascular image （ CTPA ＋ vessel）. These Two groups of images plus CTPA images were analyzed based on the lung segmentation： pulmonary trunk, lobe, segment and sub-segment. Two radiologists who were blinded retrospectively and independently recorded each patient＇ s emboli＇ s presence, location, and numbers of CTPA images alone and combined with iodine distribution maps and subtraction vessel maps. The sensitivity, specificity, false positive rate and false negative rate were evaluated for the different methods in the diagnosis of PE. Results The average processing time was 3.5 minutes. Based on the gold standard, measured IPCs were 326 in number, of which 35 were located in the trunk, 76 in the lobar segments, 133 in the segments, and 82 in the sub-segments. The sensitivities, speeificities, false positive rates and false negative rates of CTPA alone, CTPA ＋ vessel, and CTPA ＋ iodine maps, respectively, were （ 87.7%/91.7%/96.6% ）, （82. 9%/85.2%/72.7% ）, （ 12. 3%/ 8.3%/3.4% ） and （ 17.1%/14.8%/16.3% ）. The detection rate of the three methods in the pulmonary segments emboli of the lobar artery （96.1%/97.4%/98.7%）, pulmonary artery segment （85.7%/92.5%/97%） and pulmonary artery and below （76.8%/81.7%

关 键 词：体层摄影术 X线计算机 CT血管造影术 减影CTA 肺栓塞 

分 类 号：R563.5[医药卫生—呼吸系统]