多层螺旋CT肺动脉造影在急性肺栓塞诊断中的应用价值

Application of Multidetector Spiral CT Pulmonary Angiography in the Clinical Diagnosis of Acute Pulmonary Embolism

目的 研究多层螺旋CT肺动脉造影 (MSCTPA)在急性肺动脉栓塞诊断中的应用价值。方法 对临床怀疑肺动脉栓塞经MSCTPA明确诊断的 4 6例患者临床资料进行回顾性分析。结果 4 6例肺动脉栓塞患者 2 90 9支肺动脉中 6 14支显示了栓塞 ,占 2 1 1%。其中亚段肺动脉 15 75支中 ,176支显示了栓塞 ,占 11 2 %。直接征象 :中心性充盈缺损 93支 ,偏心性充盈缺损 376支 ,附壁血栓 4 9支 ,完全性阻塞 96支 ;间接征象 :玛赛克征 6例 ,胸膜下梗死灶 2 3例 ,肺动脉高压 2 4例 ,Westermark征 6例 ,胸腔积液 2 4例 ,心包积液 5例。结论 MSCTPA是诊断急性肺动脉栓塞快速、有效。

Objective To study the application of multidetector spiral CT(MSCT)in the diagnosis of acute pulmonary embolism.Methods The clinical、 MSCT and MSCTPA data of 46 PE cases were analyzed retrospectively. Results In 46 cases studied by MSCT and MSCTPA, 2909 branches of pulmonary arteries were analysed ,and PE was detected in 614 branches(21.1%) .Out of 1575 branches of subsegmental pulmonary arteries ,176 branches showed PE (11.2%). Direct signs of PE included central filling defect in 93 branches, eccentric filling defect in 376 branches, embolism attached to the wall of host artery in 49 branches, total occlusion of the pulmonary arteries in 96 branches. Indirect signs included mosaic sign in 6 cases, subpleural infarction in 23 cases, pulmonary hypertension in 24 cases, pleural effusion in 23 cases, Westermark sign in 6 cases, pericardium effusion sign in 5 cases. Conclusion MSCTPA is a fast ,effective, and non-invasive diagnostic method for PE. It may replace the pulmonary angiography and will be first choice for diagnosis of acute pulmonary embolism.