640层CT肺血管减影成像碘灌注分布图对肺动脉栓塞的诊断价值  

Diagnostic Value of Iodine Perfusion Distribution on 640-slice CT Pulmonary Vascular Subtraction Imaging in Pulmonary Embolism

作　　者：崔凤霞[1,2] 韩耀华 孙大明 徐瑶 张辉 马壮飞 张成军 Cui Fengxia;Han Yaohua;Sun Daming;Xu Yao;Zhang Hui;Ma Zhuangfei;Zhang Chengjun(Chengde Medical College,Chengde067000,China;Chaoyang Central Hospital,Chaoyang122000,China;Canon Medical Systems(Chi-na)Co.,LTD.Beijing100015,China)

机构地区：[1]承德医学院,河北承德067000 [2]朝阳市中心医院,辽宁朝阳122000 [3]佳能医疗系统(中国)有限公司,北京100015

出　　处：《辽宁医学杂志》2023年第1期79-83,共5页Medical Journal of Liaoning

摘　　要：目的 探讨采用640层宽体CT肺血管减影成像(DSCTPA)碘灌注分布图对肺动脉栓塞(PE)的诊断价值。方法 回顾性纳入2021年3月至2022年5月就诊于朝阳市中心医院临床怀疑肺栓塞的患者共64例,所有患者均先进行CT平扫,后立即行CT肺动脉血管造影(CTPA)检查,并将所得的平扫图像和CTPA图像加载到Sure-Subtraction Lung软件进行后处理,得到两组视图模式图像:Tissue模式:碘分布融合肺动脉血管像(CTPA+碘图),Vessels模式:减影后肺动脉血管图像(CTPA+血管像)。由2名医师采用双盲法对2组模式图像和CTPA图像进行诊断分析。肺动脉血管按肺动脉主干、叶、段、亚段及以下进行分类,分别记录各患者栓子的位置与数目。研究图像显示方法诊断肺栓塞的灵敏度、特异度、误诊率和漏诊率。结果 64例患者中,经CTPA检查后诊断有30例患者存在肺动脉栓塞,按标准测得的栓子共计223个,其中栓塞位于主干28个,叶肺动脉76个,段肺动脉83个,亚段及以下36个。CTPA图像、CTPA+碘图、CTPA+血管像3组显示肺动脉栓塞栓子总数的灵敏度为83.9%/91.9%/87.4%,特异度为77.8%/77.8%/76.7%,误诊率为16.1%/8.1%/12.6%,漏诊率为22.2%/22.2%/23.3%。CTPA、CTPA+碘图和CTPA+血管像三种诊断方法在各肺段栓子检出率分别为:叶肺动脉94.7%/97.4%/96.1%,段肺动脉80.7%/89.2%/84.3%,亚段及以下肺动脉55.6%/80.6%/66.7%。结论 减影所得碘灌注分布图对PE的诊断结果与CTPA对肺动脉栓塞的诊断结果具有较高的一致性。经软件减影后所得的两组视图模式有助于显示肺组织的血流灌注情况。碘灌注分布图与CTPA图像二者相结合,有助于提高亚段及以下PE的检出率,为肺栓塞的疗效评估提供更有价值的参考依据。Objective To investigate the use of 640-slice wide-body CT pulmonary vascular subtraction Diagnostic value of angiography(DSCTPA)iodine perfusion map for pulmonary embolism(PE).Methods A total of 64 patients with clinical suspicion of pulmonary embolism in Chaoyang Central Hospital from March 2021 to May 2022 were retrospectively included.All patients underwent CT plain scan, followed by CT pulmonary angiography(CTPA)immediately.The obtained plain scan images and CTPA images were loaded into sure-subtraction Lung software for post-processing, and two groups of view mode images were obtained: Tissue mode: iodine distribution combined with pulmonary artery vascular image(CTPA+ iodine image);vessel mode: pulmonary artery vascular image after subtraction(CTPA+vascular image).The two groups of mode images and CTPA images were analyzed by two physicians in a double-blind manner.The pulmonary artery vessels were classified according to the main pulmonary artery, lobe, segment, subsegment and below, and the location and number of emboli in each patient were recorded.To study the sensitivity, specificity, misdiagnosis rate and missed diagnosis rate of image display method in the diagnosis of pulmonary embolism.Results In 64 patients, 30 patients were diagnosed with pulmonary embolism after CTPA examination, 223 emboli were detected according to the standard, among which 28 emboli were located in the main trunk, 76 in the lobe pulmonary artery, 83 in the segment pulmonary artery, and 36 in the subsegment or below.The sensitivity of CTPA image, CTPA+iodine image and CTPA+vascular image to show the total number of emboli was83.9%,91.9%,87.4%,The specificity was77.8%/77.8%/76.7%,The misdiagnosis rate was 16.1%/8.1%/12.6%,The rate of missed diagnosis was22.2%/22.2%/23.3%.The detection rates of emboli in each lung segment by CTPA,CTPA+iodinogram and CTPA+angiogram were as follows: Pulmonary artery94.7%/97.4%/96.1%,Segmental pulmonary artery80.7%/89.2%/84.3%,Subsegmental and subsegmental pulmonary arteries 55.6%/80.6%/66.7%.Conc

关 键 词：肺栓塞 碘灌注分布图 减影CTA 

分 类 号：R563.5[医药卫生—呼吸系统] R816.4[医药卫生—内科学]