多层螺旋CT平扫对肺动脉栓塞的诊断价值

Clinical Application of Multislice Spiral CT Plain Diagnosis to Pulmonary Embolism

目的探讨螺旋CT平扫对肺动脉栓塞的诊断价值。方法搜集我院2009年1月至今经CT血管造影证实的肺动脉栓塞患者12例，其中男8例，女4例，年龄19—71岁，平均45岁。所有病例均行X线、CT平扫、增强及三维重建。分析CT平扫所示的间接征象对肺动脉栓塞诊断的价值。结果在常规X线检查12例中，9例表现为一侧肺野局限性片样高密度影，伴有胸腔积液。3例未见明显异常。本组12例中有2例怀疑肺动脉栓塞，并建议CT扫描。CT平扫所示，上述X线所提示的9例阳性病例表现为一侧肺内实变灶，5例实变灶尖端指向肺门，伴有单侧或双侧胸腔积液，X线表现阴性者3例中，1例肺内未见实变，也无胸水，仅表现为肺动脉密度局限性减低；2例病灶位于下叶后基底段，表现为少许索条样稍高密度影，临近胸膜腔出现少许胸水。常规X线片上被膈面遮挡，显示不清晰。此12例中10例高度怀疑肺动脉栓塞，并建议CT增强扫描、三维重建。本组12例行增强扫描，并进行工作站三维重建后，均可以看到肺动脉栓塞表现。结论X线常规摄影对肺栓塞的诊断无特异性，CT平扫间接征象对肺动脉栓塞的检出有一定价值。

Objective To evaluate spiral CT scan for diagnosis of pulmonary embolism. Methods Twelve patients of pulmonary embolism proved by angiography were enrolled, including eight males and four females aged from 19 to 71 years old （ average age was 40 years old）. All the patients had undergone X-ray and CT scan, enhanced and three-dimensional reconstruction. Results Of the 12 patients who had undergone conventional X-ray examination, nine showed unilateral high-density in lung accompanied by pleural effusion, and the other three showed no obvious abnormality. In the 12 patients, there were two ones suspected of pulmonary embolism and CT scanning was suggested. CT scan indicated unilateral lung lesions in the nine ones with positive X-ray findings, of whom five ones had the lesions pointing to hilum with unilateral or bilateral pleural effusion. In the CT scan for the three ones with negative X-ray findings, one had no lung change or pleural effusion except local reduction in pulmonary artery density, and the other two had the lesions located in the basement paragraph of the inferior leaf with a little of high density and pleural effusion. Of the 12 ones, ten highly suspected of pulmonary embolism underwent enhanced and dimensional reconstruetion, and the performance of pulmonary embolism was found in all of them. Conclusion X-ray radiography is non-specific to the diagnosis of pulmonary embolism, and CT scan with indirect signs of pulmonary embolism is of value to some extent.