螺旋CT扫描在肺动脉栓塞急慢性分期评价中的临床应用研究

Clinical significance of SCT scanning for evaluating the staging of acute and chronic pulmonary embolism

目的探讨螺旋CT扫描在肺动脉栓塞急慢性分期评价中的临床应用价值。方法回顾性收集30例肺动脉栓塞病人的胸部螺旋CT平扫及增强扫描表现,作出急性、慢性初步诊断结果,与临床分期、溶栓效果进行比较分析。结果30例肺动脉栓塞病人的82条肺动脉栓塞直接征象分为5种类型:Ⅰ型管腔中心充盈缺损,共25支;Ⅱ型附壁充盈缺损,与管壁呈锐角相交并凸向腔内,共28支;Ⅲ型附壁充盈缺损,与管壁呈钝角相交并凹向腔内,共13支;Ⅳ型管腔环形狭窄,管腔缩小50%以上,共9支;Ⅴ型血管腔完全堵塞,没有增强,共7支。Ⅰ型～Ⅴ型血栓溶栓有效率分别为92%(23/25),87.5%(24/28),21.98%(2/13),35.78%(3/9),42.86%(3/7),各组间有明显差异。Ⅰ型～Ⅳ型血栓的CT分期与临床分期比较,符合率分别为91.7%(22/25),89.3%(25/28),76.9%(10/13),77.8%(7/9),平均符合率为83.93%。结论Ⅰ型和Ⅱ型是急性肺栓塞的典型表现;Ⅲ型和Ⅳ型则是慢性肺栓塞的表现,Ⅴ型表现不能说明血栓存在的时间。CT对急性分期的区分比慢性分期更加接近于临床分期。螺旋CT是诊断肺动脉栓塞的快速、有效、无创的检查方法,在区分肺动脉栓塞急、慢性分期方面有重要的应用价值。

Objective To discuss the clinical significance of spiral computed tomography（SCT）scanning for evaluating the staging of acute and chronic pulmonary embolism（PE）. Methods Thirty patients with PE underwent CT scans of the chest without and with contrast medium. Based on CT findings in all patients, the preliminary diagnosis and staging of acute and chronic PE were performed and compared with clinical staging and thrombolytic efficacy. Results The direct signs in 82 pulmomary arteries of 30 cases on CT images were divided into following five kinds of types： type Ⅰ presented filling defect of luminal center （n = 25）, type Ⅱ was filling defect of attachment walls, attachment substances and wails were connected by a closed angle and were prominent toward luminal inside （n = 28）, type Ⅲ was filling defect of attachment wails but attachment substances and walls were connected by an obtuse angle and indented into luminal inside （n = 13）, type Ⅳ presented as a circular narrowing of lumina, luminal reduction was over 50 % （n = 9）, and type Ⅴ presented complete occlusion of lumina and non - enhanccment after injection of contrast medium （n = 7）. The effective rate of thrombolytic therapy in various types of patients was 92 % （23/25） for type Ⅰ, 85.7 % （24/28） for type Ⅱ, 21.98 % （2/13） for type Ⅲ, 35.78 % （3/9） for type Ⅳ, and 42.86 % （3/7） for type Ⅴ, respectively, there was significant difference between various groups. Compared with clinical staging, the corresponding rate of CT staging was 91.7 % （22/25）for type Ⅰ, 89.3 % （25/28）for type Ⅱ, 76.9 % （10/13）for type Ⅲ and 77.8 % （7/9）for type Ⅳ, respectively, mean correspcnding rate between CT - and clinical staging was 83.93 %. Conclusion Type Ⅰ and Ⅱ presented acute PE while type Ⅲ and Ⅳ presented chronic PE. However, the manifestations of type Ⅴ are difficuhhy to explain the duration of thrombi presence. CT staging of acute PE is more approximate to clinical staging than that of chronic PE. SCT is a quick, effective and noninvasive modality in the detection of PE and is very helpful to differentiate acute PE from chronic PE.