多层螺旋计算机断层扫描肺动脉造影成像参数对急性肺动脉栓塞危险分层的评估价值

Evaluation Value of Multislice Spiral Computed Tomography Imaging Parameters in Risk Stratification of Acute Pulmonary Embolism

目的探讨多层螺旋计算机断层扫描(CT)肺动脉造影成像参数对急性肺动脉栓塞危险分层的评估价值。方法以2018年1月至2022年12月河南中医药大学第一附属医院收治的185例急性肺动脉栓塞患者为研究对象,根据其危险分层分为中低危组、中高危组、高危组,分别为77、64、44例。统计3组一般资料,比较3组多层螺旋CT肺动脉造影成像影像学表现及造影成像参数。采用受试者工作特征(ROC)曲线分析多层螺旋CT肺动脉造影成像参数单独及联合诊断高危急性肺动脉栓塞的价值。结果中高危组、高危组累及肺动脉、累及肺叶动脉患者占比高于中低危组(P<0.05);高危组累及肺段动脉占比高于中高危组和中低危组,中高危组高于中低危组(P<0.05)。高危组主肺动脉(PA)/胸主动脉(AO)、上腔静脉直径(SVC)、右心室短轴直径(RVD)/左心室短轴直径(LVD)高于中高危组和中低危组,中高危组高于中低危组(P<0.05)。PA/AO、SVC、RVD/LVD联合诊断的曲线下面积(AUC)值高于三者单独诊断(P<0.05);PA/AO及联合诊断的敏感度高于SVC、RVD/LVD,联合诊断的敏感度高于PA/AO(P<0.05);SVC、RVD/LVD及联合诊断的特异度高于PA/AO(P<0.05)。结论不同危险分层急性肺动脉栓塞患者多层螺旋CT肺动脉造影成像影像学表现及多层螺旋CT肺动脉造影成像PA/AO、SVC、RVD/LVD具有明显差异,PA/AO、SVC、RVD/LVD联合对高危急性肺动脉栓塞患者的诊断价值较好。

Objective To explore the value of multi-slice spiral computed tomography(CT)pulmonary angiography imaging parameters in assessing the risk stratification of acute pulmonary embolism.Methods A total of 185 patients with acute pulmonary embolism admitted to the First Affiliated Hospital of Henan University of Traditional Chinese Medicine Hospital from January 2018 to December 2022 were selected as the research objects.According to their risk stratification,they were divided into the medium-low risk group,medium-high risk group and the high risk group,with 77 cases,64 cases and 44 cases,respectively.General data of the three groups were collected.and the imaging findings and imaging parameters of multi-slice spiral CT pulmonary angiography were compared.The value of multi-slice spiral CT pulmonary angiography imaging parameters alone and in combination in the diagnosis of high-risk acute pulmonary embolism was analyzed using receiver operating characteristic(ROC)curves.Results The proportion of patients with pulmonary artery and pulmonary artery involvement in the high-risk group and the high-risk group was higher than that in the low-risk group.The proportion of pulmonary artery involved in the high-risk group was higher than that in the high-risk group and the low-risk group,and the medium-high-risk group was higher than that in the low-risk group(P<0.05).The main pulmonary artery(PA)/thoracic aorta(AO),superior vena cava diameter(SVC),right ventricular short axis diameter(RVD)/left ventricular short axis diameter(LVD)in the high-risk group were higher than those in the medium-high-risk group and the medium-low risk group,and the medium-high risk group was higher than those in the medium-low risk group(P<0.05).The area under curve(AUC)value of PA/AO,SVC,RVD/LVD combined diagnosis was higher than that of the three diagnoses alone(P<0.05).The sensitivity of PA/AO and combined diagnosis was higher than that of SVC and RVD/LVD,and the sensitivity of combined diagnosis was higher than that of PA/AO(P<0.05).The specificity of SVC,RVD/LVD and combined diagnosis was higher than that of PA/AO(P<0.05).Conclusion There were differences in the imaging findings of multislice spiral CT pulmonary angiography and in the imaging of PA/AO,SVC,and RVD/LVD of multislice spiral CT pulmonary angiography in patients with acute pulmonary embolism at different risk levels.The combination of PA/AO,SVC,and RVD/LVD has better diagnostic value for high-risk acute pulmonary embolism patients.