MSCTPA对肺栓塞患者右心功能的诊断价值

Diagnostic value of CT pulmonary angiography for right ventricular with pulmonary embolism in patients

目的以超声心动图作为诊断右心功能的标准,探讨64层CT肺血管造影(CTPA)对肺栓塞患者右心功能的诊断价值。方法前瞻性收集了临床疑诊肺栓塞的41例行CTPA检查的患者,阳性组根据右心功能、肺动脉栓塞部位及肺动脉压力指数分组,薄层数据进行最大密度投影(MIP)、多平面重建(MPR)和容积再现(VRT),分析各组数据中右心功能参数的差异。结果 41例患者中肺栓塞阳性24例,阴性17例,CTPA诊断右心功能不全13例,超声心动图诊断右心功能不全11例。以超声心动图为标准,64层CTPA诊断右心功能不全的灵敏度为76.9%,特异度为90.9%,阳性预测值90.9%,阴性预测值76.9%,Kappa值为0.669,诊断具有中度一致性。对于主肺动脉干(PA)、升主动脉(Aorta)、上腔静脉(SVC)、奇静脉(AV)、冠状静脉窦(CS)、PA/Aorta比、LVd、RVd及RVd/LVd比之间比较,第一组中差异有统计学意义的指标有PA、PA/Aorta比,LVd、RVd及RVd/LVd,CS;第二组中差异均无统计学意义;第三组中,差异有统计学意义的指标有PA/Aorta比。结论 MSCTPA及其后处理重建技术可以在诊断肺栓塞的同时对心功能作出评价。

Objective The purpose of this study was to assess the diagnostic value of 64-slice CT pulmonary angiography （CTPA） with right heart function in patients with pulmonary embolism as the reference standard of echocardiography. Methods We prospectively collected 41 patients of clinically suspected pulmonary embolism with routine CTPA examina- tion. Positive group according to right heart function, pulmonary embolism and pulmonary arterial pressure index of sites were grouped. Thinning data for maximum intensity projection （MIP）, multiplanar reconstruction （MPR） and volume rendering （VRT）, were analysed for every group differences in right heart function parameters. Results In 24 of 41 pa- tients with PE, 64-CTPA identified that 13 patients were positive for RVD. Meanwhile, 11 cases were diagnosed as posi- tive by UCG. In comparison with UCG, the diagnostic sensitivity, specificity, positive predictive value and negative pre- dictive value of CTPA were 76.9 %, 90.9 %, 90.9 % and 76.9 %, respectively. Kappa value was 0. 669, which suggested moderate agreement between 64-CTPA and UCG in the whole level. Cardiovascular parameters including main pulmonary, ascending aorta, superior vena cava diameters, azygos vein diameters,coronary sinus diameters, PA / Aorta ratio, Right ventricular diameter （RVd）, left ventricular diameter （LVd） and RVd/LVd ratio were measured. For the first group, PA, PA/Aorta ratio, LVd, RVd and RVd/LVd, CS were significant; All of cardiovascular parameters for the second group were not significant; For the third group, only PA/Aorta ratio was significant. Conclusion These results suggest that MSCTPA and post-processing techniques are a practical and accurate means for evaluating RV function of pulmonary embolism in patients.