胸部CT平扫诊断急性肺血栓栓塞症的价值分析  

Value analysis of non-contrast chest CT in the diagnosis of acute pulmonary thromboembolism

作　　者：孟夏培 杨浩宇 席霖枫 刘安琪 黄振国[5] 刘敏[5] MENG Xiapei;YANG Haoyu;XI Linfeng;LIU Anqi;HUANG Zhenguo;LIU Min(Department of Radiology,Tianjin Hexi District Traditional Chinese Medicine Hospital,Tianjin 300222,China;Peking University China-Japan Friendship School of Clinical Medicine,Beijing 100029,China;Capital Medical University China-Japan Friendship School of Clinical Medicine,Beijing 100069,China;Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;Department of Radiology,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]天津市河西区中医医院影像科,天津300222 [2]北京大学中日友好临床医学院,北京100029 [3]首都医科大学中日友好临床医学院,北京100069 [4]中国医学科学院&北京协和医学院,北京100730 [5]中日友好医院放射诊断科,北京100029

出　　处：《实用放射学杂志》2025年第1期32-36,共5页Journal of Practical Radiology

基　　金：国家自然科学基金项目(82272081)。

摘　　要：目的探讨胸部CT平扫对急性肺血栓栓塞症(APTE)的诊断价值。方法纳入可疑APTE行CT肺动脉造影(CTPA)检查的患者187例,均完成胸部CT平扫及2 h内CTPA。187例患者中包括89例APTE患者(APTE组)及98例无APTE患者(对照组)。对APTE组与对照组的临床特征及胸部CT特征进行比较,并分析胸部CT平扫特征诊断中央型APTE和周围型APTE的敏感度、特异度。结果APTE组中胸部CT显示肺动脉高密度征35例,对照组0例,2组间有统计学差异(χ^(2)=47.414,P<0.001);APTE组出现胸膜下阴影33例,对照组11例,2组间有显著统计学差异(χ^(2)=17.327,P<0.001)。肺动脉高密度征诊断中央型APTE敏感度、特异度为72.92%、100%,诊断周围型APTE敏感度、特异度为0%、100%;胸膜下阴影诊断中央型APTE的敏感度、特异度为39.58%、88.78%,诊断周围型APTE的敏感度、特异度为34.15%、88.78%。胸腔积液、肺动脉直径、肺动脉直径与主动脉直径比在2组间无显著统计学差异。结论胸部CT平扫显示的肺动脉高密度征是APTE的特异性征象,该征象出现可以避免进一步CTPA检查。Objective To explore the diagnostic value of non-contrast chest CT in acute pulmonary thromboembolism(APTE).Methods A total of 187 patients with suspected APTE who underwent non-contrast chest CT and computed tomography pulmonary angiography(CTPA)within 2 h were included.Among 187 patients,there were 89 patients with APTE(APTE group)and 98 patients without APTE(control group).The clinical characteristics and chest CT features between the APTE group and the control group were compared.The sensitivity and specificity of non-contrast chest CT findings in the diagnosis of central APTE and peripheral APTE were analyzed.Results Chest CT showed pulmonary artery hyperdensity sign in 35 cases in the APTE group and none in the control group,with the difference was statistically significant(χ^(2)=47.414,P<0.001);Subpleural shadow appeared in 33 cases in the APTE group and 11 cases in the control group,with the difference was statistically significant(χ^(2)=17.327,P<0.001).The sensitivity and specificity of pulmonary artery hyperdensity sign in the diagnosis of central APTE and peripheral APTE were 72.92%,100%and 0%,100%,respectively.The sensitivity and specificity of subpleural shadow in the diagnosis of central APTE and peripheral APTE were 39.58%,88.78%and 34.15%,88.78%,respectively.The difference was not statistically significant in pleural effusion,pulmonary artery diameter,or pulmonary artery diameter to aorta diameter ratio between the two groups.Conclusion The pulmonary artery hyperdensity sign on non-contrast chest CT is a useful sign of APTE,which can avoid CTPA examination.

关 键 词：胸部CT平扫 急性肺血栓栓塞症 肺动脉高密度征 

分 类 号：R814.42[医药卫生—影像医学与核医学] R543.2[医药卫生—放射医学]