64层CT肺动脉造影对肺栓塞诊断及治疗后复查的应用研究

The application of pulmonary angiography with 64-slice CT in the diagnosis of pulmonary embolism and follow-up after treatment

目的:探讨64层CT肺动脉造影(CTPA)对肺栓塞的诊断效果及治疗后复查的价值。方法:对32例肺动脉栓塞的患者采用64层CT行CTPA检查,并进行多平面重建(MPR)、最大密度投影及容积重建处理。患者复查采用相同CT检查及后处理重建。结果:32例患者中15例有下肢静脉栓塞、4例有恶性肿瘤、3例有近期手术病史,2例有近期外伤史。CTPA对肺动脉主干、左右肺动脉及叶、段、亚段动脉显示良好,32例患者中显示受累肺动脉221支,其直接征象为肺动脉血管内充盈缺损,间接征象包括肺梗死实变、肺野少血征、胸腔积液等。肺栓塞治疗后复查有24例患者1月内肺动脉栓子消失或明显吸收缩小(占75%);6例患者吸收不明显(占18.7%);2例死亡。结论:64层CT能清楚地显示肺栓塞的形态、部位及其它间接征象,并能有效监测治疗效果,为临床提供有益帮助。

Objective：To explore the value of CT pulmonary angiography（CTPA） with 64-slice CT in the diagnosis of pulmonary embolism（PE） and follow-up after treatment.Methods：Thirty-two patients with PE were examined with CTPA by 64-slice CT and processed multiple planar reconstruction（MPR）,maximum intensity projection（MIP）,and volume reconstruction（VR）.All the follow-up was subjected to the same CT examinatoin and reconstruction.Results：Of 32 cases,15 cases had deep venous thrombosis（DVT）,4 cases had malignant tumor,3 cases had operation history recently,2 cases had injury history recently.Main pulmonary trunk,left or right pulmonary branch,and lobar,segmental or subsegmental pulmonary artery were displayed well with 64-slice CT,221 branches were displayed,direct sign was pulmonic filling defect,indirect signs included pulmonary embolism,lung lack of blood,pleural effusion and so on.After treatment,the follow-up examination showed that 24 cases had the pulmonary artery thrombus disappeared or mainly absorbed.6 cases absorbed unobviously,2 cases died.Conclusion：The anatomic distribution and shape of PE and other indirect signs can be clearly demonstrated with 64-slice CT,and it can effiectively survey the treatment of PE,which is helpful to select the strategy of treatment.