肺栓塞CT血管造影的诊断标准和误诊分析

Diagnostic criteria and causes of misdiagnosis in CT angiography of pulmonary embolism

CT肺动脉血管造影在诊断肺动脉栓塞中已成为标准的检测手段,不论其急性或慢性肺栓塞,都可造成具有锐利界面的部分或全部的血管内充盈缺损。急性肺栓塞表现为完全性动脉闭塞时,其病变动脉可增大;部分性充盈缺损时,栓塞常为中心性;偏心性充盈缺损时,则与血管壁形成锐角表现。慢性肺栓塞时,可表现为血管完全性闭塞性改变,并较附近正常血管管径为小。本文综述了CT肺动脉造影的诊断标准以及肺栓塞诊断中可能误诊的原因。

Computed tomographic （CT） pulmonary angiography is becoming the standard of care for the evaluation of patients with suspected pulmonary embolism. This pathologic condition, whether acute or chronic, causes both partial and complete intraluminal filling defects. In acute pulmonary embolism that manifests as complet arterial occlusion, the affected artery may be enlarged. Partial filling defects due to acute pulmonary embolism are often centrally located, but when eccentrically located they form acute angles with the vessel wall. Chronic pulmonary embolism can manifest as complete occlusive disease in vessels that are smaller than adjacent patent vessels. In this article, the author described the technique of CT pulmonary angiography, diagnostic criteria for acute and chronic pulmonary embolism, and causes of mis- diagnosis of pulmonary embolism.