多层螺旋CT肺动脉血管造影在肺动脉栓塞中的诊断价值  

Value of multi-detector CT pulmonary angiography in diagnosis of pulmonary embolism

作　　者：农剑波[1] 李耀波[1] 陆仕业 罗燕婷[1] NONG Jianbo, LI Yaobo, LU Shiye, LUO Yanting(Department of Radiology, the First People′s Hospital of Nanning, Nanning, Guangxi 530022, Chin)

机构地区：[1]广西南宁市第一人民医院放射科,南宁市530022

出　　处：《微创医学》2018年第4期436-438,444,共4页Journal of Minimally Invasive Medicine

摘　　要：目的探讨多层螺旋CT肺动脉血管造影(MDCTPA)在肺动脉栓塞诊断中的效果。方法收集82例经MDCTPA检查确诊为肺动脉栓塞的患者,分析MDCTPA图像经多平面重建、容积再现、最大密度投影处理后对肺动脉及其栓子的显示情况,并总结肺动脉栓塞的MDCTPA直接征象与间接征象。结果 (1)82例肺动脉栓塞患者经多层螺旋CT扫描显示,有405支肺动脉或分支受累,其中16支肺段动脉、81支肺叶动脉、128支肺动脉干、15支累及肺左/右动脉、165支亚段动脉或以下动脉分支;(2)肺动脉栓塞的MDCTPA直接征象表现为:40例附壁血栓、15例完全阻塞型充盈缺损、9例中心型充盈缺损、18例偏心型充盈缺损;(3)肺动脉栓塞的MDCTPA间接征象表现为:12例肺纹理稀疏、细小,22例肺呈斑片状渗出或实变影,28例肺动脉高压,17例心包或胸腔积液,3例肺梗死灶形成。结论 MDCTPA应用于肺动脉栓塞诊断中具有简单快捷、无创、准确率高等优点,能够直观显示栓子的位置和形态以及管腔狭窄程度,可为疾病早期诊断及疗效评估提供参考依据。Objective To explore the efficacy of multi-detector CT pulmonary angiography（ MDCTPA）in the diagnosis of pulmonary embolism. Methods A total of 82 patients with pulmonary embolism diagnosed by MDCT were selected. The display of pulmonary arteries and their embolus were assessed after MDCT pulmonar y angiography image edited by multi-planar reconstruction,volume reconstruction and maximum density projection. The direct and indirect signs of pulmonary embolism in MDCTPA were summarized.Results（1） In 82 patients with pulmonary embolism,multi-detector CT scan revealed that 405 pulmonary arteries or branches were involved,including 16 pulmonary segmental arteries,81 lobar arteries,128 pulmonary trunk,15 left/right pulmonary arteries and 165 sub-segmental-arteries or the branches.（2） MDCTPA direct signs of pulmonary embolism included mural thrombus（ n = 40）,completely blocked filling defect（ n = 15）,central filling defect（ n = 9） and eccentric filling defect（ n = 18）.（3） MDCTPA indirect signs of pulmonary embolism included sparse and small lung texture（ n = 12） pulmonary patchy exudation or consolidation（ n = 22）,pulmonary hypertension（ n = 28）,pericardial or pleural effusion（ n = 17） and pulmonary infarction（ n = 3）. Conclusion The application of MDCTPA to the diagnosis of pulmonary embolism is simple,quick,noninvasive and accurate. It can directly display the position and shape of the embolus and the stenosis degree of the lumen,and can provide a reference for the early diagnosis and evaluation of the efficacy.

关 键 词：多层螺旋CT 肺动脉栓塞 肺动脉 造影 诊断价值 

分 类 号：R445[医药卫生—影像医学与核医学]