中心型慢性肺动脉血栓栓塞的增强MR特征及其临床应用价值  

Enhanced MR features of central chronic pulmonary artery thromboembolism and the clinical application value

作　　者：杨泽俊 刘明熙[2] 龚娟妮[3] 李文欢 马展鸿[2] 杨媛华[3] 缪冉[3] 郭晓娟[2] Zejun Yang;Mingxi Liu;Juanni Gong;Wenhuan Li;Zhanhong Ma;Yuanhua Yang;Ran Miao;Xiaojuan Guo(Capital Medical University,Beijing 100069,China;Department of Radiology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China;Department of Pulmonary and Critical Care Medicine,Capital Medical University,Beijing Chaoyang Hospital,Beijing 100020,China)

机构地区：[1]首都医科大学,北京100069 [2]首都医科大学附属北京朝阳医院放射科,北京100020 [3]首都医科大学附属北京朝阳医院呼吸与危重症学科,北京100020

出　　处：《中华放射学杂志》2023年第3期266-273,共8页Chinese Journal of Radiology

摘　　要：目的探讨中心型慢性肺动脉血栓栓塞(CPTE)的增强MR影像特征与肺血管阻力(PVR)的关系。方法回顾性收集首都医科大学附属北京朝阳医院2018年1月至2020年12月诊治的, 且进行增强MR检查的中心型CPTE患者共39例, 评估其肺动脉影像学特征。根据其中33例患者的右心导管数据, 以PVR=1 000 dyn·s·cm^(-5)为阈值分为两组, 比较两组间增强MR影像特征差异, 并以性别、年龄、病程、胸膜增厚、双侧支气管扩张、受累血管节段数、血栓数及血栓部位管壁延迟强化节段数为自变量进行二分类logistics回归分析。结果 39例中心型CPTE患者受累肺动脉多表现为管腔扩张(168段, 43.30%)以及管壁延迟强化(122段, 31.52%)。血栓处动脉以管腔扩张发生率最高(66段, 52.80%)。PVR<1 000 dyn·s·cm^(-5)组的血栓多于PVR≥1 000 dyn·s·cm^(-5)组(χ^(2)=9.55, P=0.002), 血栓部位管壁延迟强化发生率在两组间差异无统计学意义(χ^(2)=0.90, P=0.344)。PVR<1 000 dyn·s·cm^(-5)组双侧支气管动脉扩张发生率高于PVR≥1 000 dyn·s·cm^(-5)组(P=0.019)。Logistic回归分析结果表明女性、较少受累血管节段数及双侧支气管动脉扩张与较低PVR相关。结论增强MRI有助于精准评估中心型CPTE患者肺动脉管腔异常和管壁重构情况, 这对于病情及疗效评估具有重要的意义。Objective To explore the relationship between the imaging features of enhanced MRI in patients with central chronic pulmonary artery thromboembolism(CPTE)and pulmonary vascular resistance(PVR).Methods Thirty-nine patients with CPTE who had contrast-enhanced MRI examination were retrospectively enrolled this study from January 2018 to December 2020.And 33 patients who received right heart catheterization were divided into two groups based on PVR=1000 dyn·s·cm^(-5).The differences of imaging features of CPTE in enhanced MRI between the two groups were compared.The relationship between gender,duration of disease,age,pleural thickening,bilateral bronchial artery dilation,number of the involved vascular segments,number of thrombosis,number of the thrombus-related delayed enhancement of artery wall and PVR was analyzed by binary logistic regression.Results In 39 patients with central CPTE,the dilated lumen(168,43.30%)and delayed enhancement of wall(122,31.52%)were found in most of pulmonary arteries.The rate of the lumen dilatation associated with thrombus was the highest among that of the lumen abnormality(66,52.80%).There were more thrombi in PVR<1000 dyn·s·cm^(-5) group than those in PVR≥1000 dyn·s·cm^(-5) group(χ^(2)=9.55,P=0.002).There was no significant difference in the incidence of wall delayed enhancement associated the thrombus between the two groups(χ^(2)=0.90,P=0.344).The incidence of bilateral bronchial arterial dilatation in PVR<1000 dyn·s·cm^(-5) group was higher than that in PVR≥1000 dyn·s·cm^(-5) group(P=0.019).Logistic regression analysis showed that female,the less number of involved vascular segments and bilateral bronchial artery dilation were correlated with the lower PVR.Conclusions Enhanced MRI is helpful to accurately evaluate the lumen abnormality of pulmonary artery and wall remodeling in central CPTE,which is of great value for the assessment of patients′conditions and treatment effect.

关 键 词：血栓栓塞 肺动脉 磁共振成像 肺血管阻力 

分 类 号：R445.2[医药卫生—影像医学与核医学] R563.5[医药卫生—诊断学]