螺旋CT血管成像在不同类型急性肺动脉栓塞患者的应用及影像学表现  

CT angiography in patients with different Types of acute pulmonary embolism and its imaging findings

作　　者：丁玉姣 石容容 张启杰 鄢高亮[1] 王佳佳 徐秋贞[1] DING Yujiao;SHI Rongrong;ZHANG Qijie;YAN Gaoliang;WANG Jiajia;XU Qiuzhen(Department of Radiology, Jiangbei Hospital of Zhongda Hospital Affiliated in Southeast Unviersity, Nanjing 210044, China;Department of Medical Imaging, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi 214000, China)

机构地区：[1]东南大学附属中大医院江北院区放射科,江苏南京210044 [2]南京医科大学附属无锡人民医院医学影像科,江苏无锡214000

出　　处：《医学影像学杂志》2022年第3期419-423,共5页Journal of Medical Imaging

基　　金：国家自然科学基金资助项目(编号:81600227)。

摘　　要：目的探讨128排螺旋CT血管成像(CTA)在不同类型急性肺动脉栓塞(PE)患者的应用及影像学表现。方法选取我院2018年1月~2020年4月期间收治的行CTA检查的94例PE患者的临床影像资料。根据PE受累部位将患者分为中央型组和周围型组。分析两种类型PE患者的CTA征象及临床特点,并对两组CTA胸部继发改变情况进行比较。结果94例急性PE患者中22例为危重患者;急性PE患者CTA的直接征象为血管腔内充盈缺损或完全阻塞,其他征象有局部肺纹理稀少、肺部斑片状阴影、支气管动脉增粗等;94例急性PE中44例中央型,栓子位于血管中心,栓子周围为高密度对比剂,表现为“环征”或“轨道征”,50例周围型,栓子位于血管一侧或四周,血管中心或对侧充盈高密度对比剂;中央型急性PE患者危险分层中危重占比明显高于周围型,差异有统计学意义(P<0.05),此外多数患者接受了对症及抗凝治疗,中央型8例患者接受了溶栓治疗,两组其他临床特征比较,差异均无统计学意义(均P>0.05);94例急性PE中78例(占83.0%)出现胸部继发性病理改变,其中中央型41例,周围型37例,主要为右心增大、肺动脉高压、心包积液、马赛克征、肺梗死等,其中中央型组右心增大、肺动脉高压、肺梗死及马赛克征的发生率明显高于周围型组,差异具有统计学意义(P<0.05)。结论中央型急性PE病情更重,容易出现右心增大、肺动脉高压、心包积液、马赛克征、肺梗死等一系列胸部继发性病理改变。128排螺旋CTA检查在急性PE诊断及治疗中具有一定应用价值。Objective To analyze the application and imaging findings of CT angiography in patients with different types of acute pulmonary embolism(PE).Methods CTA data of 94 PE patients in our hospital from January 2018 to April 2020 were collected.They were divided into the central group and the peripheral group according to the affected site of PE.The CTA signs and clinical characteristics of two types of PE patients were analyzed,and the secondary changes of chest under CTA were compared between two groups.Results Of the 94 patients with acute PE,22 were in critical condition;The direct signs of CTA in acute PE patients were vascular cavity filling defect or complete obstruction,and other signs included sparse local lung texture,patchy lung shadows,and thickened bronchial arteries;Of the 94 cases of acute PE,44 were of central type,with emboli in the center of the blood vessel,surrounded by high-density contrast agent,presenting as"ring sign"or"track sign";50 were of peripheral type,with emboli on one side or around the blood vessel,and filled with high-density contrast agent in the center or contralateral of the blood vessel;The proportion of critical patients in the risk stratification of acute PE patients in the central type was significantly higher than that in the peripheral type,and the difference was statistically significant(P<0.05).In addition,most of the patients received symptomatic and anticoagulant therapy,while 8 patients in the central type received thrombolytic therapy.Comparison of other clinical characteristics between the two groups showed no statistically significant difference(all P>0.05);of 94 cases of patients with acute PE 78 cases(83.0%)appeared in secondary pathological changes of chest,including central type in 41 cases,peripheral type in 37 cases,mainly presenting with the right heart enlargement,pulmonary hypertension,pericardial effusion,Mosaic,pulmonary infarction,etc.,in which the central group of right heart enlargement,pulmonary hypertension,pulmonary infarction,and incidence of Mosaic

关 键 词：体层摄影术 X线计算机 血管成像 肺动脉栓塞 急性 影像学 

分 类 号：R543.2[医药卫生—心血管疾病] R814.42[医药卫生—内科学]