急性肺栓塞治疗前后双能量肺灌注成像的半定量对比研究  

Comparative study of semi-quantitative analysis on dual energy lung perfusion imaging in acute pulmonary embolism before and after treatment

作　　者：李培秀[1] 耿园园[1] 焦亚彬[2] 都日娜[2] 张彦宗[1] 徐建[1] 王红辉 

机构地区：[1]中国石油天然气集团公司中心医院影像科,河北廊坊065000 [2]中国石油天然气集团公司中心医院心血管外科,河北廊坊065000

出　　处：《实用放射学杂志》2017年第12期1847-1850,1862,共5页Journal of Practical Radiology

摘　　要：目的 探讨双能量肺灌注成像（DEPI）的半定量分析在急性肺栓塞（PE）治疗前后疗效评价方面的应用价值。方法 选取经双源CT肺动脉造影（CTPA）及DEPI确诊为急性PE患者25例，治疗后复查CTPA、DEPI，分别统计治疗前后CTPA所示栓子数目、部位、栓塞程度，治疗前后不同类型栓子DEPI视觉分析法阳性率，并比较PE治疗前后2组间栓塞区与对照区肺组织灌注CT值的差值。结果 将CTPA所示栓子按其分布部位和栓塞程度分为4型：中央型闭塞型、中央型非闭塞型、周围型闭塞型、周围型非闭塞型。以CTPA为参照标准，治疗前CTPA所示287个栓子中，其视觉分析阳性率依次为100.00%、70.54%、87.23%、76.19%。治疗后的81个栓子的视觉阳性率分别为100.00%、76.67%、86.67%、77.78%。中央型闭塞型PE、中央型非闭塞型PE、周围型闭塞型PE这3种类型在治疗前后DEPI半定量分析中均存在统计学差异［分别为（70.7±10.1）HU vs （29.8±6.0） HU，P＜0.01；（50.1±9.6） HU vs（29.3±7.8） HU，P＜0.01；（53.4±11.4） HU vs （27.4±8.9） HU，P＜0.01］。周围型非闭塞型PE虽治疗前后CT值差值较前减少［（28.5±9.0） HU vs （24.5±8.2） HU］，但2组间差异无统计学差异（P＞0.05）。结论 双源CTPA联合DEPI视觉分析及半定量分析能够对PE治疗前后评估提供更加全面、客观的依据。Objective To investigate the application of semi-quantitative analysis of dual energy lung perfusion imaging （DEPI） in patients with acute pulmonary embolism （PE） before and after treatment. Methods 25 patients with acute PE diagnosed by dual source CT were recruited consecutively. All of them underwent CT pulmonary angiography （CTPA） and DEPI before and after treatment. Radiologists visually evaluated the PE numbers, its distribution （central or peripheral） and its nature （occlusive or nomocclusive） on CTPA. DEPI visual analysis and semi-quantitative analysis before and after treatment in different types of PE evaluated by CTPA were analyzed statistically. Results Four types of PE （central occlusive PE, central non-occlusive PE, peripheral occlusive PE and peripheral non-occlusive PE） were classified according to embolic sites and the extent of embolization. Comparing to CTPA as a standard reference, the positive rates of DEPI visual analysis were 100.00 0%, 70.54 %, 87.23 %, 76.19 % before treatment, 100.00 %, 76.67%,86.67 %,77.78 % after treatment, respectively. Significant differences were found in central occlusive PE, central non-occlusive PE and peripheral occlusive PE with mean difference of CT values before and after treatment [（70.7±10.1） HU vs （29.8± 6.0） HU, P 〈0.01;（ 50.1 ± 9.6） HU vs （29.3±7.8） HU,P〈 0.01;（53.4±11.4） HU vs （27.4±8.9） HU,P〈0.01, respectively]. Although （24.5±8.2） HU （after treatment） were lower than （28.5± 9.0） HU （before treatment） , no significant difference was found in the type of peripheral non-occlusive PE （P〉 0.05）.Conclusion The combination of CTPA and DEPI can offer more comprehensive information of the acute PE therapeutic evaluation before and after treatment.

关 键 词：肺栓塞 计算机体层成像 

分 类 号：R563.5[医药卫生—呼吸系统] R814.42[医药卫生—内科学]