能谱CT全肺平均灌注碘基值对急性肺动脉栓塞危险分层的效果评估  

Assessment of the effect of whole-lung mean perfusion iodine concentration of energy-spectrum CT on the risk stratification of acute pulmonary embolism

作　　者：朱林 卢冉[3] 郭飞[1,4] ZHU Lin;LU Ran;GUO Fei(Department of Radiology,First Affiliated Hospital of Bengbu Medical College,Bengbu 233004,China;Graduate School of Bengbu Medical College;Department of Vascular Surgery,First Affiliated Hospital of Bengbu Medical College;Department of Medical Imaging Diagnosis,School of Medical Imaging,Bengbu Medical College)

机构地区：[1]蚌埠医学院第一附属医院放射科,蚌埠233004 [2]蚌埠医学院研究生院 [3]蚌埠医学院第一附属医院血管外科 [4]蚌埠医学院医学影像学院医学影像诊断教研室

出　　处：《国际医学放射学杂志》2022年第5期503-507,共5页International Journal of Medical Radiology

基　　金：安徽省教育厅重点项目(KJ2019A0327)。

摘　　要：目的探讨全肺平均灌注碘基值(vMeanIP)用于急性肺动脉栓塞(APE)危险评估的价值。方法回顾性收集经能谱CT检查确诊的64例APE病人,男36例,女28例,平均年龄(59.8±14.9)岁。根据2019版欧洲心脏病学会(ESC)指南中血流动力学状态、右心室功能及心脏生物标志物将APE病人分为高危组(20例)、中高危组(23例)及中低危组(21例)。在能谱CT影像中测量vMeanIP、兴趣区灌注缺损碘基值(ROI vPD)、右心室与左心室的直径比值(rRL)、栓子累及的动脉等相关参数。采用单因素方差分析、Kruskal-Wallis检验和卡方检验比较3组间各参数的差异。采用受试者操作特征(ROC)曲线评估vMeanIP、ROI vPD对高危APE病人危险分层的预测价值,并计算其ROC曲线下面积(AUC)、敏感度及特异度。结果3组间病人年龄差异有统计学意义,其中高危组病人年龄高于中低危组(P<0.05)。3组间CT参数和栓子累及动脉的差异均有统计学意义(均P<0.05),其中,中低危组的ROI vPD和vMeanIP均高于中高危组和高危组(均P<0.05),中高危组的vMeanIP高于高危组(P<0.05)。中低危组的rRL和栓子累动脉比例均低于中高危组和高危组(均P<0.05)。3组间其他参数比较差异均无统计学意义(均P>0.05)。vMeanIP预测高危APE病人危险分层的AUC(0.835)和特异度(75.0%)均高于ROI vPD(分别为0.785和52.3%),而敏感度(80.0%)低于ROI vPD(100.0%)。结论vMeanIP可用于评估APE病人危险分层的严重程度及病情进展,对临床具有指导意义。Objective To investigate the value of whole lung mean perfusion iodine concentration(vMeanIP)in the risk assessment of acute pulmonary embolism(APE).Methods All of 64 patients with APE diagnosed by spectral CT examination were retrospectively collected,including 36 males and 28 females,with an average age of 59.8±14.9 years.Patients were divided into three groups:high risk group(20 cases),medium-high risk group(23 cases),and medium-low risk group(21 cases)based on hemodynamic status,right ventricular function,and cardiac biomarker according to the 2019 European Society of Cardiology(ESC)guidelines.The parameters of vMeanIP,iodine concentration of perfusion defects in the region of interest(ROI vPD),ratio of the diameter of right ventricle to the diameter of left ventricle(rRL),emboli involvement of main pulmonary trunk and subsegmental pulmonary artery were measured on spectral CT images.One-way analysis of variance,Kruskal-Wallis test and chi-square test were used to compare the differences of parameters among the three groups.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of vMeanIP and ROI vPD for risk stratification in high-risk APE patients,and the area under the ROC curve(AUC),sensitivity and specificity were calculated.Results There was a significant difference in age among the three groups,and the age of the high-risk group was higher than that of the medium-low risk group(P<0.05).There were statistically significant differences in CT parameters and emboli involved arteries among the three groups(all P<0.05).The ROI vPD and vMeanIP of the medium-low risk group were higher than those of the medium-high risk group and the high-risk group(all P<0.05),and the vMeanIP of the mediumhigh risk group was higher than that of the high-risk group(P<0.05).The rRL and the proportion of embolic artery in the medium-low risk group were lower than those in the medium-high risk group and the high-risk group(all P<0.05).There were no significant differences in other parameters amo

关 键 词：能谱CT 全肺平均灌注碘基值 急性肺动脉栓塞 危险分层 

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