双源CT双能量肺灌注成像技术诊断急性肺动脉栓塞的临床应用

Application of dual energy CT lung perfusion imaging in diagnosis of patients with acute pulmonary embolism

目的:探讨双源CT肺灌注成像(DEPI)技术诊断急性肺动脉栓塞的价值。方法:13例急性肺动脉栓塞患者应用双源CT进行肺动脉成像(CTPA)扫描,所得扫描图像经采用Lung PBV软件处理得到CTPA、DE-PI图像及两种能量成像的融合图像,将CTPA上所示肺动脉内栓子的数量、位置与相应肺叶、肺段、肺亚段组织灌注状态相对照。结果:CTPA共检出26个肺叶、57个肺段内有栓子存在。在肺叶基础上,DEPI检出灌注缺损或降低25个,符合率为92.0%;在肺段基础上,DEPI检出52个,符合率为89.0%。当段、亚段肺动脉栓塞充盈缺损为完全时,相应的DEPI主要是肺段或亚段分布的灌注缺损,分别占84.0%、63.0%。而当充盈缺损为部分时,DEPI以灌注降低为主,少数表现为无灌注缺损,相反,4个肺段区显示灌注缺损,而CTPA未见异常。结论:DEPI表现与CTPA上肺动脉栓塞程度、部位有关,两者联合起来有助于提高急性肺动脉栓塞诊断率。

Objective：To assess the diagnostic value of dual source CT dual energy perfusion imaging（DEPI） for pulmonary embolism.Method：Thirteen consecutive patients with acute pulmonary embolism underwent dual energy imaging,the images were evaluated with lung PBV software on the workstation,after CT pulmonary angiography（CTPA）,DEPI and fusion image were obtained.The number and location of PE in DEP I and CTPA were recorded and analyzed.Result：Twenty-five branches and 57 subbranches were involved with pulmonary embolism.The 92%,89% agreement between DEPI and CTPA were showed in the levels of lung and partial lung respectively.Complete filling defects of segmental and subsegmental pulmonary arteries mostly showed correspondence perfusion defects in the CT perfusion map,accounting for 84% and 63% respectively.Howeven,when there were partial filling defects,most of them were partial perfusion defects.A few of them were normal in the CT perfusion map.Otherwise,segmental perfusion defects were depicted without the visualization of endoluminal thrombi in some patients.Conclusion：There was moderate agreement between the judgement of CTPA and DEPI.The perfusion defects in the DEPI related to the degree and location of the filling defects in the CTPA.The combination of CTPA and DEPI will offer more information for diagnosis of the acute pulmonary embolism.