CT定量肺血管体积对急性肺栓塞患者右心功能的评价研究  

CT quantitative measurement of pulmonary vessel volume to evaluate right ventricular function in patients with acute pulmonary embolism

作　　者：高婷[1] 王一帆[1] 孙潇[1] 杨晓娜 周嘉鑫 马丽[1] 朱力[1] GAO Ting;WANG Yi-fan;SUN Xiao;YANG Xiao-na;ZHOU Jia-xin;MA Li;ZHU Li(Department of Radiology,General Hospital of Ningxia Medical University,Yinchuan Ningxia 750004,China;Ningxia Medical University,Yinchuan Ningxia 750004,China)

机构地区：[1]宁夏医科大学总医院放射科,宁夏银川750004 [2]宁夏医科大学,宁夏银川750004

出　　处：《中国临床医学影像杂志》2023年第9期659-663,668,共6页Journal of China Clinic Medical Imaging

基　　金：宁夏回族自治区重点研发计划类项目(2022BEG03077)。

摘　　要：目的:探讨分析肺血管体积评价急性肺栓塞(Acute pulmonary embolism,APE)患者病情严重程度的价值。方法:本研究回顾性收集114例APE患者和50例行CT肺动脉造影(CTPA)检查表现为阴性者(对照组)的资料。入组的APE患者按照危险分层指标右心室短轴直径与左心室短轴直径比值(RVd/LVd)分为中高危组(RVd/LVd≥1)和低危组(RVd/LVd<1),其中中高危组62例,低危组52例。基于CTPA图像测量右心功能参数,包括RVd/LVd、主肺动脉直径(PA)、PA与升主动脉直径比值(PA/Ao)。根据Qanadli算法计算肺动脉栓塞指数(PAOI)。自动分析软件定量测量肺血管体积参数,包括不同截面积肺血管体积百分比%BV5、%BV5~10、%BV10(%BV5、%BV5~10、%BV10分别表示肺血管截面积小于5 mm^(2)、5~10 mm^(2)、小于10 mm^(2)的肺血管体积与肺体积之比。采用单因素方差分析或Kruskal-Wallis H检验比较中高危组、低危组和对照组的肺血管体积及右心功能参数的差异,根据参数是否服从正态分布,选择Pearson或Spearman相关性分析用于检验APE患者肺血管体积参数与右心室功能参数的相关性。结果:对照组、低危组和中高危组间肺血管体积参数%BV5、%BV5~10、%BV10均依次减少,差异有统计学意义(P<0.001)。相关性分析显示,%BV10与RVd/LVd的相关性最显著(r=-0.510,P<0.001),肺血管体积参数与PAOI的相关性弱。结论:肺血管体积参数与右心功能参数呈负相关,可以用于评估APE患者的病情严重程度。Objective:To explore the value of pulmonary vascular volume in evaluating the severity of the disease in patients with acute pulmonary embolism(APE).Methods:The total of 114 patients with APE and 50 normal controls with negative CT pulmonary angiography(CTPA)results were collected.According to the risk stratification index,APE patients were divided into two subgroups:intermediate-high-risk group(the ratio of right ventricular short axis diameter to left ventricular short axis diameter(RVd/LVd)≥1)and low-risk group(RVd/LVd1),including 62 patients in the intermediate-high-risk group and52 patients in the low-risk group.The right ventricular function parameters were measured on CTPA image,including RVd/LVd,main pulmonary artery diameter(PA),and the ratio of main pulmonary artery diameter to ascending aorta diameter(PA/Ao).The pulmonary artery obstruction index(PAOI)in patients with APE was calculated using Qanadli's algorithm.The pulmonary vascular volume parameters were quantitatively measured by automatic analysis soft,including the percentage of pulmonary vascular volume in different cross-sectional areas%BV5,%BV5~10,%BV10(%BV5,%BV5~10,%BV10 indicated the ratio of pulmonary vascular volume to lung volume with cross-sectional area less than 5 mm^(2),5~10 mm^(2)and less than 10 mm^(2),respectively).One-way ANOVA or Kruskal-Wallis H test was used to compare the differences of the pulmonary vascular volume parameters and right ventricular function parameters in intermediate-high-risk group,low-risk group and control group.According to whether the parameters follow normal distribution,Pearson or Spearman correlation analysis was selected to ana-lyze the correlation between pulmonary vascular volume parameters and right ventricular function parameters in patients with APE.Results:The pulmonary vascular volume parameters%BV5,%BV5~10 and%BV10 decreased gradually among the control group,low risk group and intermediate-high-risk group,and the difference was statistically significant(P0.001).Spearman correlation revealed

关 键 词：肺栓塞 心室功能 右 体层摄影术 X线计算机 

分 类 号：R563.5[医药卫生—呼吸系统] R814.42[医药卫生—内科学]