螺旋CT血管造影对肺栓塞的临床诊断价值

Spiral CT angiography in diagnosis of pulmonary embolism

目的前瞻性评价螺旋CT血管造影对临床疑诊为肺栓塞的诊断价值。方法对32例临床疑诊为肺栓塞的患者行螺旋CT血管造影(SCTA)及二维或三维重建,所有患者经多种影像检查方法和/或临床治疗随访证实。SCTA扫描参数取层厚3.0,螺距(pitch)1.5,用SmartPrep软件对比剂智能触发技术获得最佳延迟扫描时间。结果32例临床疑诊肺栓塞中,21例肺栓塞共累及肺动脉105支;SCTA确诊了19例,2例5个亚段肺动脉的栓子漏诊。在11例肺栓塞阴性中,SCTA对10例作出了正确诊断:2例肺癌,4例肺炎,1例夹层动脉瘤,3例未见明显异常;另外1例肺动脉肉瘤,SCTA误诊为肺栓塞。SCTA诊断肺栓塞的特异性90.9%,敏感性90.5%,准确性90.6,阳性预测值95.0%,阴性预测值83.3%。结论螺旋CT血管造影无创、快速、敏感性及特异性高,可作为诊断肺栓塞的首选检查方法。

Objective To prospectively evaluate the diagnostic value of spiral CT angiography（SCTA） in the suspected pulmonary embolism（PE）, Methods 32 cases of clinically suspected PE were examined with SCTA, and proved by the other imaging modalities and/or clinical treatment. The optimal delay time was acquired through SmartPrep software, Slice thickness 3,0mm, pitch 1.5 were used. Results 21 of 32 cases were PE involving 105 branches, SCTA helped correctly identify 19 of 21 cases with PE, and misdiagnosed 2 casess with PE involving 5 branches. 10 of the 11 cases without PE, SCTA provided correctly diagnosis： lung cancer（n=2）, pneumonia（n=4）, aortc dissection （n=1）, normal （n=3）. 1 case of pulmonary artery sarcoma was incorrectly diagnosed as PE. The specificity, sensitivity, accuracy, positive predictive value and negative predictive value for the diagnosis of PE with SCTA were 90.9%,90.5%, 90.6%, 95.0%, 83.3% respectively. Condusion The SC-TA is non-invasive, fast, highly sensitive and specific for PE, and it should be the modality of choice of the diagnosis of PE.