20例肺动脉栓塞螺旋CT增强扫描的影像分析

Contrast-enhanced CT of Pulmonary Embolism:Report of 20 Cases

目的:研究肺动脉栓塞螺旋CT增强扫描的影像表现,充分认识肺栓塞的CT征象,提高肺栓塞的诊断水平。方法:共20例,男14例,女6例。使用东芝Xpress/SXCT扫描机作造影增强螺旋CT扫描。统计分析肺叶及肺叶以上肺动脉栓塞CT增强的综合表现。结果:肺动脉栓塞原发病以下肢深静脉血栓形成最为多见,有7例。下肢深静脉血栓有2例是由桑拿浴引起。将肺栓塞的程度分为轻度栓塞、中度栓塞、重度栓塞和完全栓塞。轻度栓塞为栓塞面占肺动脉管径<30%;中度栓塞为栓塞面30%～50%;重度栓塞为栓塞面>50%,周围仍见对比剂显影或通过;完全栓塞的栓塞面周边无对比剂显影通过。肺动脉栓塞直接征象是栓塞部位不强化,呈充盈缺损改变。此外,还见9个继发征象:肺动脉总干增宽,右心室和右心房增大。肺叶透亮度增加,肺血管纹理稀疏、细小。肺静脉变小,基底静脉变小,边缘不整,呈干藤样改变。左心房变小。左心室亦变小,室间隔向左后移位。肺组织实变,呈三角形。胸腔积液和心包积液。结论:肺动脉栓塞胸部螺旋CT增强扫描的表现是一组综合征象,笔者称为肺栓塞10联征。充分认识10联征,能大大提高肺栓塞的诊断水平。肺动脉栓塞有多种原发病,以下肢深静脉血栓形成最多见,桑拿浴可引起下肢深静脉血栓,可能是肺栓塞的一个诱因。

Objective：To study the Characteristics of pulmonary embolism （PE） in contrast-enhanced CT. Methods： There were 20 patients （14 male and 6 female） with lobar and proximal PE were scanned with a Toshiba Xpress/SX CT scanner after contrast material was administrated. The CT manifestations were noted. Results： The direct sign of PE was filling defect or no opacification at the embolizing site of the affected branch of pulmonary artery （PA）. And there were 9 secondary signs of PE： PA widening; dilatation of right ventricle and atrium;increased lucency of the affected lobe and rarefaction and thinning of lung markings;small dried-rattan-like pulmonary vein; small left atrium and ventricle; posterior and leftward shift of the interventricular septum;triangular consolidation of affected lung parenchyma;and pleural effusion;and pericardiac effusion. Conclusion：The manifestations of PE on contrast-enhanced CT include a series of 10 signs. With full understanding of these 10 signs correct diagnosis of pulmonary embolism can be made.