老年肺栓塞患者溶栓治疗后CT肺动脉造影及CT肺灌注成像参数变化及意义  

Changes and significances of CT pulmonary angiography and CT perfusion imaging indexes after thrombolysis in elderly patients with pulmonary embolism

作　　者：郭华[1] GUO Hua(Imaging Centerthe First Affiliated Hospital of Henan University of Science and Technology,Luoyang,Henan 471000,China)

机构地区：[1]河南科技大学第一附属医院影像中心,河南洛阳471000

出　　处：《中华实用诊断与治疗杂志》2022年第1期64-67,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省医学科技攻关计划(201504030)。

摘　　要：目的分析老年肺栓塞患者溶栓治疗前后CT肺动脉造影(CT pulmonary angiography,CTPA)及CT肺灌注成像(CT perfusion imaging,CTP)参数变化,探讨二者在老年肺栓塞溶栓治疗效果评估中的应用价值。方法老年肺栓塞患者45例,均应用重组组织型纤溶酶原激活剂+肝素行溶栓治疗。分别于溶栓治疗前及溶栓治疗后1个月行CT平扫及增强扫描,通过Vitrea工作站获得CTPA、CTP图像。比较溶栓治疗前后CT容积剂量指数、剂量长度乘积、图像质量评分、对比度噪声比、信噪比;比较溶栓治疗前后CTPA、CTP图像检出栓子数目、部位、类型,CTPA图像下肺栓塞评分、肺栓塞指数、右心室/左心室横径比,CTP图像下肺灌注缺损评分、肺灌注缺损指数。45例患者根据治疗效果分为治愈组14例,有效组24例,无效组7例,比较3组栓子数目改善指数、肺栓塞评分改善指数、肺栓塞指数改善指数、右心室/左心室横径比改善指数、肺灌注缺损评分改善指数及肺灌注缺损指数改善指数。结果溶栓治疗前后CT容积剂量指数、剂量长度乘积、图像质量评分、对比度噪声比、信噪比比较差异均无统计学意义(P>0.05)。溶栓治疗前,CTPA检出254个栓子,CTP检出279个栓子。溶栓治疗后,治愈组14例患者CTPA图像显示栓子消失,CTP图像显示4例亚段肺动脉有灌注缺损;有效组24例患者CTPA图像显示栓子数目减少,CTP图像显示肺灌注缺损减少。溶栓治疗后肺栓塞评分[(1.19±0.12)分]、肺栓塞指数(2.57±0.09)、右心室/左心室横径比(0.81±0.09)及肺灌注缺损评分[(1.78±0.32)分]、肺灌注缺损指数(4.42±1.32)均低于治疗前[(6.21±1.87)分、15.83±3.12、0.89±0.11、(6.94±2.01)分、17.02±2.43](P<0.05)。CTPA图像下,治愈组栓子数目改善指数、肺栓塞评分改善指数、肺栓塞指数改善指数(1.00±0.00、1.00±0.00、1.00±0.00)均高于有效组(0.60±0.21、0.63±0.17、0.59±0.16)和无效组(0.07±0.01、Objective To analyze the changes of CT pulmonary angiography(CTPA)and CT perfusion imaging(CTP)indexes before and after thrombolysis in elderly patients with pulmonary embolism(PE),and to investigate the value of combined application of them two to the evaluation of thrombolytic efficacy.Methods Forty-five elderly PE patients received thrombolysis with recombinant human tissue-type plasiminogen and heparin.CT scan and enhancement were performed before and one month after thrombolysis.The CTPA and CTP images were acquired at Vitrea station.CT dose index volume,dose length product,image quality evaluation,contrast-to-noise ratio and signal-to-noise ratio were compared before and after thrombolysis.The number,site and type of emboli,the pulmonary embolism score(PEE),pulmonary embolism index(PEI)and right/left ventricular transverse diameter ratio(RVd/LVd)under CTPA,as well as pulmonary perfusion defect evaluation(PPDE)and pulmonary perfusion defect index(PPDI)under CTP were observed and compared before and after thrombolysis.According to the therapeutic efficacy,45 patients were divided into recovery group(n=14),effective group(n=24)and ineffective group(n=7).The improvement indexes of number of emboli,PEE,PEI,RVd/LVd,PPDE and PPDI were compared among three groups.Results There were no significant differences in CT dose index volume,dose length product,image quality evaluation score,contrast-to-noise ratio and signal-to-noise ratio after treatment compared with those before treatment(P>0.05).Before treatment,CTPA detected 254 emboli and CTP detected 279 emboli.After treatment,14 patients with completely disappeared emboli under CTPA in recovery group were found emboli in subsegmental pulmonary artery under CTP in 4 patients;effective group showed decreased number of emboli under CTPA and decreased pulmonary perfusion defect under CTP.PEE,PEI,RVd/LVd,PPDE and PPDI were lower after thrombolysis(1.19±0.12,2.57±0.09,0.81±0.09,1.78±0.32,4.42±1.32)than those before thrombolysis(6.21±1.87,15.83±3.12,0.89±0.11,6.94�

关 键 词：肺栓塞 CT肺动脉造影 CT肺灌注成像 

分 类 号：R563.5[医药卫生—呼吸系统]