急性肺动脉栓塞的CT表现与疾病严重程度的关系

Correlation between CT features and clinical severity stratification in acute pulmonary embolism

目的回顾性分析急性肺动脉栓塞(PE)的 CT 表现与疾病严重程度相关的因素,并探讨 CT 肺动脉造影(CTPA)评价急性 PE 严重程度的价值。方法 48例经 CTPA 确诊的急性 PE 患者,根据其疾病严重程度分为危重组21例和非危重组27例。对两组的栓塞指数、中央肺动脉受累比例、右心室最大层面短轴(RVMMA)和左心室最大层面短轴(LVMMA)比(RV∶LV)、主肺动脉和(或)右肺动脉干、支气管动脉扩张情况进行对比分析,探讨 CT 表现中与 PE 疾病严重程度相关的因素,并对RV∶LV 和栓塞指数进行相关性分析。结果危重组21例的肺动脉栓塞指数(22%～85%,中位数38%)、中央肺动脉受累(占42.5%)、RV∶LV(0.90～1.90,中位数1.30)、肺动脉扩张(14例)、支气管动脉扩张(8例)情况经统计学分析均高于非危重组;非危重组27例的肺动脉栓塞指数为5%～48%(中位数22%),中央肺动脉受累占31%,RV∶LV 为0.80～1.40(中位数1.00),肺动脉扩张5例,支气管动脉扩张3例。两组比较差异有统计学意义(分别为 Z=4.27、X^2=5.40、Z=2.58、X^2=11.45、X^2=4.87,P 值均<0.05);RV∶LV 与栓塞指数呈正相关(r=0.61,P<0.05)。结论CTPA 评价急性 PE 的危重程度是可行的,栓塞指数、RV∶LV 和中央肺动脉受累占的百分比越大,PE患者发生严重血流动力学改变的几率越高。

Objective To analyze the correlation factors between CT imaging features of pulmonary embolism （PE） and clinical severity stratification, to explore the value of CT pulmonary angiography （CTPA） in acute PE severity stratification. Methods According to the clinical severity, 48 patients with acute PE proved by CTPA were classified into two groups, including 21 critical and 27 non-critical patients. Embolism index, ratio of central pulmonary involvement, ratio of right ventricle maximum minor axis （RVMMA） to left ventricle maximum minor axis （ LVMMA）, namely RV： LV, dilation of main pulmonary and/or right pulmonary trunk, and dilation of bronchial arteries in both groups were analyzed comparatively. The correlation factors between CT imaging features and PE clinical severity stratification were explored. The correlation between RV： LV and embolism index of 48 patients was analyzed. Results Pulmonary embolism index （22. 0%-85.0%, median 38.0% ）, ratio of central pulmonary involvement （42.5%）, RV： LV （0.90-1.90, median 1.30）, dilation of pulmonary artery （14 cases）, and dilation of bronchial artery （8 cases） in critical group （21 cases） were higher than those corresponding factors （5%-48%, median 21.5%, 31.25%, 0. 80-1.40, median 1.00, 5 cases, and 3 cases） in non-critical group （27 cases） （Z = 4. 27, χ^2 = 5.40, Z = 2. 58, χ^2 = 11.45, χ^2 = 4. 87, P 〈 0. 05 ）. There was remarkable correlation between RV： LV and embolism index （r = 0. 61, P 〈 0. 05 ）. Conclusion CTPA is feasible in evaluating PE severity stratification. The higher the embolism index, RV： LV, and the ratio of central pulmonary involvement, the higher probability of serious hemodynamic changes in PE patients.