多层螺旋CT在肺动脉栓塞临床诊断及治疗中的应用

Clinical application of multislice spiral CT in the diagnosis and treatment of pulmonary embolism

目的评价多层螺旋CT在诊断和治疗肺动脉栓塞中的临床应用价值。方法回顾性分析35例经螺旋CT检查确诊的肺动脉栓塞患者。均使用西门子SOMATOMSPIRIT多层螺旋CT行平扫及增强容积扫描。观察血栓累及的部位、程度及范围,并对部分溶栓治疗后患者进行螺旋CT复查,评估治疗效果。结果35例肺动脉栓塞累及肺动脉主干及其分支共187支,主干2支;左右肺动脉主干及分支均累及96支,仪肺动脉分支累及89支;增强后肺动脉栓塞的直接征象为不同程度的肺动脉主干及分支的充盈缺损,有4种表现形式:部分充盈缺损67支,完全闭塞47支,附壁充盈缺损38支,轨道征35支。间接征象表现为肺灌注期马赛克征6例,肺梗死灶8例,肺动脉高压4例,胸腔积液27例。16例溶栓治疗后患者复查见肺动脉主干及分支栓子部分和完全吸收。结论多层螺旋CT肺动脉造影是诊断肺动脉栓塞的快速、有效、无创伤的诊断方法,在栓塞的定性和定量诊断及临床治疗后观察上,可以起到重要作用。

Objective To evaluate the clinical application of muhislice spiral CT （MSCT） in the diagnosis and treatment of pulmonary embolism （PE）. Methods Thirty-five patients with PE confirmed by MSCT were retrospective analyzed, then underwent non- enhanced and volume contrast-enhanced scan. To observe the position, degree and range of thrombus, evaluate the therapeutic efficacy to the part of patients by thrombolysis. Results In 35 patients confirmed by MSCT, 187 branches main and segmental pulmonary arteries showed PE, 2 main pulmonary artery, 96 showed PE in right/ left main pulmonary arteries and branches, only 89 branches segmental pulmonary, artery showed PE. The direct sigh was the filling defect in the pulmonary arteries branches at various degrees, and four forms of the filling defect including part filling defect in 67 branches, total occlusion of the pulmonary, arteries in 47 branches, embolism attached to the wall of host artery in 38 branches, railway-track signs in 35 branches. The indirect sighs of the MSCT include： mosaic sighs （6 cases）, lung infarct!on （8 cases）, pulmonary hypertension （4 cases）, pleural effusion （27 cases）. Part or complete absorption underwent thrombolysis with MSCT can be found in 16 patients. Conclusion MSCT is a fast, effective, and non-invasive diagnostic method for PE. It will play an important role in clinical qualitation and quantitation diagnosis of PE.