肺血管疾病螺旋CT肺动脉造影诊断

Spiral CT pulmonary angiography in diagnosis of pulmonary vascular diseases

目的 探讨螺旋CT肺动脉造影 (SCTPA)在肺血管疾病诊断中的临床应用价值。方法 对 65例肺血管疾病行SCTPA检查 ,包括先天性肺血管疾病 (肺动静脉瘘 6例 ,特发性肺动脉扩张 8例 ,肺动脉发育不全 3例 ,一侧肺动脉缺如1例及肺静脉畸形引流 5例 )、获得性肺血管疾病 (肺动脉栓塞 41例 ,大动脉炎累及肺动脉 1例 )。SCTPA扫描层厚 3mm ,螺距 1～ 1.5 ,亚秒级扫描时间 0 .8秒 ,重建层厚 1mm ,重建方法包括MIP、MPR和SSD。结果 SCTPA对 6例肺动静脉瘘共显示供血动脉 13条、引流静脉 9条和瘤囊 8个 ,漏诊 1例多发性肺动静脉中的小瘤囊 ;特发性肺动脉扩张、肺动脉发育不全、一侧肺动脉缺如者SCTPA均能明确诊断 ;5例肺静脉畸形引流中的心外畸形部分SCTPA与手术对照良好 ;45例肺动脉栓塞 ,SCTPA诊断中心型肺栓塞 3 5例 ,周围型肺栓塞 6例。结论 SCTPA既可以显示肺血管的形态、结构与走行 ,又可显示肺血管内特征 ,对肺血管疾病的诊断有较高的临床实用价值 。

Objective To evaluate the clinical application of spiral CT pulmonary angiography (SCTPA) in the diagnosis of pulmonary vascular diseases(PVD). Methods Sixty-five cases with different kinds of PVD were analyzed, including congenital pulmonary vascular diseases (6 cases with pulmonary arterial-venous fistula, 8 cases with idiopathic pulmonary artery dilatation, 3 cases with pulmonary artery dysgensis, 1 case with unilateral pulmonary artery agenesia, 5 cases with pulmonary venous abnormal drainage) and acquired pulmonary vascular diseases (41 cases with pulmonary embolism, 1 case with pulmonary arteritis of Takayasu' diseases). All patients were performed SCTPA with slice thickness 3 mm, pitch 1～ 1.5 , scanning time 0.8s, reconstruction thickness 1mm. The reconstruction of SCTPA was SSD, MIP and MPR. Results 13 feeding pulmonary arteries, 9 drainage pulmonary veins and 8 niduses in 6 cases with pulmonary arterial-venous fistula (AVF) were demonstrated by SCTPA. But 1 nidus of a multiple AVF was missed; All cases with idiopathic pulmonary artery dilatation, pulmonary artery dysgensis, unilateral pulmonary artery agenesia were well showed; The abnormal structures outside the heart of 5 cases with pulmonary venous abnormal drainage showed on SCTPA corresponded well with the operations. 41 cases of pulmonary embolism with central type (35 cases) and periphery type (6 cases) were clearly detected by SCTPA. Conclusion SCTPA is an effective and noninvasive method in the diagnosis of PVD. It can not only demonstrate the morphology and structure of pulmonary vessels but also detect the intraluminal feature of pulmonary vessel. It can partly replace the invasive pulmonary angiography because of its high clinical value in the diagnosis of PVD.