CTVPA在肺栓塞和下肢静脉血栓形成中的应用

Application of CT Veno-pulmonary Arteriography in the Diagnosis of Pulmonary Embolism and Deep Venous Thrombosis of Lower Limb

目的：探讨多层螺旋CT下肢静脉和肺动脉联合成像（CTVPA）在肺栓塞（PE）及下肢静脉血栓形成（DVT）中的临床应用价值。方法：48例临床疑诊PE患者进行CTVPA检查。所有患者先行增强后肺动脉扫描，延迟180～240s后再行下肢静脉扫描。结果：CTVPA示PE和DVT均表现为血管腔内充盈缺损。48例中CTVPA检出PE和下肢DVT并存者24例，其中双下肢DVT7例，左或右下肢DVT17例；单纯PE4例，单纯下肢DVT15例，右髂外静脉孤立性DVT2例，下腔静脉孤立性DVT1例，2例无明显栓塞征象。和PE并存的下肢DVT中，右下肢（15例）明显多于左下肢（2例），差异有统计学意义（Х^2=14．1，P〈0．05）。结论：CTVPA可同时诊断PE和下肢DVT，具有良好的成本-效益比；右下肢DVT比左下肢更易发展为PE。

Objective： To explore the clinical value of CT veno-pulmonary arteriography （CTVPA） in the diagnosis of pulmonary embolism （PE） and deep venous thrombosis （DVT） of lower limb. Methods：48 patients who had clinically sus- pected PE underwent CTVPA study. All patients had pulmonary artery scan first, then after 180-240s delayed, venous scan of lower limbs was performed. Results：PE and DVT showed intra-luminal filling defect of blood vessels on CTVPA. Of the 48 patients,24 patients had both PE and DVT detected by CTVPA, with bilateral lower limb DVT（n=7） or unilateral （left or right） lower limb DVT （n= 17）. 4 patients had PE only; 15 patients had only lower limb DVT, 2 patients had isolated DVT in external iliac vein and one patient had inferior vena caval DVT. There was no obvious PE or DVT findings on CTVPA in 2 patients. Of the patients had both PE and DVT,DVT of right limb （n= 15） was obviously more than that in left limb （n=2）,statistical difference was existed （Х^2= 14.1 ,P〈0.05）. Conclusion：PE and DVT of lower limbs could be detected simultaneously by CTVPA,showing good cost-efficacy benefit. DVT of right lower limb showed higher tendency in causing PE than that of left lower limb.