电子束CT诊断肺动脉栓塞  

The diagnosis of pulmonary embolism by electron beam computed tomography

作　　者：郑敏文[1] 宦怡[1] 葛雅丽[1] 石明国[1] 赵宏亮[1] 白桂琴[1] 李剑[1] 

机构地区：[1]第四军医大学西京医院放射科,陕西西安710032

出　　处：《心脏杂志》2004年第2期152-155,共4页Chinese Heart Journal

摘　　要：目的 ::评价电子束 CT(EBCT)对肺动脉栓塞的诊断价值与优势。方法 :对 2 0 0 2 - 0 5～ 2 0 0 3- 0 4经 EBCT确诊的 9例肺栓塞的 CT征象进行分析 ,探讨其诊断价值。结果 :左、右两侧段以上肺动脉发生栓塞的几率相近 ,右侧5 2 .6 % (71/ 135 ) ,左侧 4 9.6 % (6 7/ 135 ) ,右侧略高。但左侧闭塞的段以上肺动脉有 19支 ,右侧仅 4支。各叶段以上肺栓塞的发生率以下叶最高 ,达 6 1.1% (6 6 / 10 8) ,其次为上叶的 4 5 .8% (33/ 72 )和中叶及舌叶的 4 0 .7% (2 2 / 5 4 )。左、右中间肺动脉的栓塞率为 5 0 % (9/ 18)。 36 0支亚段肺动脉中有 115支栓塞 (31.9% ) ,其中明确的栓塞 76支 (包括 2 6支闭塞 ) ,可疑 39支。肺栓塞的 EBCT直接征象 :管腔内中心性或偏心性充盈缺损及“轨道征”、“漂浮征”和完全闭塞 (闭塞血管管径大于正常管径 )。间接征象 :偶可见“马赛克征”和梗死灶 ,多数见局限性肺纹理稀疏。另外还有胸水、肺动脉及右心轻度扩张等。结论 :电子束 CT扫描速度快 ,运动伪影小 ,对段以上肺栓塞能清晰显像并准确诊断 ,可作为肺栓塞的首选无创性检查方法。局限性是空间分辨率低 ,对亚段以下肺动脉栓塞的评价并不十分可靠。AIM: To evaluate the values and advantages of electron beam computed tomography(EBCT) in diagnosing pulmonary embolism(PE). METHODS: From May 2002 to April 2003,nine patients were confirmed having acute PE by using EBCT and all the images were retrospectively analysed. RESULTS:The incidence of PE in right superior-segmental pulmonary arteries was 52.6% and that of the left was 49.6%,with the former a little more than the latter. The 19 occluded pulmonary arteries were on left and only 4 on the right. Of all the pulmonary lobes, the lower ones had the highest incidence of PE(61.6%), and then was upper lobes(45.8%) and median or ligula lobe(40.7%) followed. 115 of 360 PE subsegments were found and only 76 were confirmed. The direct EBCT signs of acute PE were central intraluminal filling defect, 'railway-track sign', 'float sign',and occlusion(the diameter of the occluded pulmonary artery was larger than normal ).The indirect EBCT sign of PE were 'mosaic sign' and pulmonary infarction in some cases,but the majority of cases had local oligemia,pleural fluid and enlargement of the pulmonary artey and the right ventricle. CONCLUSION:Electron beam tomography is a noninvasive and effective diagnostic technique for central pulmonary emlolism.

关 键 词：肺栓塞 体层射影术 X线计算机 

分 类 号：R563.5[医药卫生—呼吸系统]