不同CT窗技术及后处理技术对肺栓塞的诊断价值  

Diagnostic value of different CT window techniques and post-processing techniques for pulmonary embolism

作　　者：张艳[1,2] 邬山 祝家成[1,2] 王一力 钱俊翔 曾富俐 卫泳岑 张中星 ZHANG Yan;WU Shan;ZHU Jiacheng;WANG Yili;QIAN Junxiang;ZENG Fuli;WEI Yongcen;ZHANG Zhongxing(Chongqing Three Gorges Medical College,Chongqing404000,China;Department of Radiology,Affiliated Hospital of Chongqing Three Gorges Medical College,Chongqing404000,China;Department of Respiratory and Critical Care Medicine,Affiliated Hospital of Chongqing Three Gorges Medical College,Chongqing404000,China)

机构地区：[1]重庆三峡医药高等专科学校,重庆404000 [2]重庆三峡医药高等专科学校附属医院放射科,重庆404000 [3]重庆三峡医药高等专科学校附属医院呼吸与危重症医学科,重庆404000

出　　处：《中国现代医生》2020年第17期141-143,共3页China Modern Doctor

摘　　要：目的评价不同CT窗技术及后处理技术对肺栓塞的诊断价值。方法回顾性分析2018年9月~2020年1月在我院行CTPA确诊的45例肺栓塞患者的资料,分别应用常规纵膈窗及常用调节窗、常规纵膈窗+调节窗观察肺栓塞的位置(段以上、段及段以下)及阳性血管数,以纵膈窗联合调节窗检出的肺栓塞作为金标准。比较最大密度投影(MIP)、多平面重组(MPR)和容积重建(VR)三种后处理技术对不同位置的肺动脉显示率,组间比较采用χ2检验。结果段及段以下肺栓塞,单独使用调节窗的漏诊率低于单独使用纵膈窗,分别为3.3%、12.5%,差异有统计学意义(P<0.05)。段以上肺栓塞,单独应用常用调节窗、纵膈窗漏诊率分别为4.5%、13.6%,组间比较差异无统计学意义(P>0.05)。MPR对段及段以下肺动脉栓塞的显示率优于MIP及VR影像,差异具有统计学意义(P<0.05)。结论在阅读CTPA图像中,单纯使用常规纵膈窗或常用调节窗都可漏掉部分栓塞,特别是较小血管的栓塞,临床工作中,应常规使用纵膈窗+常用调节窗宽、MPR重建技术减少肺栓塞的漏诊。Objective To evaluate the diagnostic value of different CT window techniques and post-processing techniques for pulmonary embolism(PE).Methods The data of 45 patients diagnosed with PE by CTPA in our hospital from September 2018 to January 2020 were retrospectively analyzed.The positions(above,at and below the segment)and the number of positive vessels of PE were observed through conventional mediastinal window,common regulatory window,and conventional mediastinal window plus regulatory window respectively.The PE detected by mediastinal window combined with regulatory window was taken as the golden criteria.The display rates of pulmonary artery at different positions by the three post-processing techniques of maximal intensity projection(MIP),multiplanar reformation(MPR)and volume reconstruction(VR)were compared.Chi-square test was used for the comparison among the groups.Results For PE at and below the segment,the missed diagnosis rate of the regulatory window alone(3.3%)was lower than that of the mediastinal window alone(12.5%)with statistically significant difference(P<0.05).For PE above the segment,the missed diagnosis rates of common regulatory window alone and mediastinal window were respectively 4.5%and 13.6%,with no statistical difference among the groups(P>0.05).MPR was superior to MIP and VR images in the display rate of PE at and below the segment,and the differences were statistically significant(P<0.05).Conclusion In reading CTPA images,the use of conventional mediastinal window alone or common regulatory window alone might miss some embolisms,especially those of smaller vessels.In clinical work,mediastinal window plus common regulatory window width and MPR reconstruction technique should be used routinely to reduce missed diagnosis of PE.

关 键 词：窗技术 重建技术 肺栓塞 CT 

分 类 号：R816.4[医药卫生—放射医学]