心源性肺水肿的X线与CT对比研究

Comparison of the lung X-ray and CT imaging features of patients with cardiogenic pulmonary edema

目的分析心源性肺水肿患者的肺部X线与CT影像学表现，从而提高心源性肺水肿患者的诊断准确率。方法自2010年1月至2013年1月共收治100例心源性肺水肿患者，均于发病24h内分别对患者行肺部X线与CT检查，对比分析其影像学表现。结果急性心源性肺水肿X线表现以肺泡性肺水肿为主，X线表现与肺部CT影像学表现相似，为腺泡结节、斑片状及大片融合影，有时可见空气支气管像，病变边缘模糊。病变进展时双肺出现广泛的密度均匀实变阴影，典型者出现“蝶翼征”。病。变征象检出率，二者比较差异无统计学意义。慢性心源性肺水肿多表现为间质性肺水肿，肺部X线与CT影像学表现以肺血重新分布，肺野透光度降低，肺纹理增多、增重，小叶间隔线增厚如胸膜下线、克氏线出现以及肺实质磨玻璃样变等间质性肺水肿改变为主，病变征象检查率、肺部CT征象分辨率较高，二者比较差异有统计学意义（P〈0．05）。结论急性心源性肺水肿的肺部X线与CT征象表现相似，临床诊断率相当，而慢性心源性肺水肿的肺部CT检查能提供更多的诊断信息，提高临床诊断率。

Objective To analyze the lung X-ray and CT imaging features of patients with car- diogenic pulmonary edema, thereby enhancing the diagnostic accuracy in patients with the cardiogenic pulmonary edema. Methods From January 2010 to January 2013, 100 patients with cardiogenic pulmo- nary edema were selected, all patients underwent the lung X-ray and CT examinations within 24 hours of onset, and then comparative analysis of the imaging manifestations was made. Results Acute cardiogen-ic pulmonary edema X-ray showed pulmonary edema with alveolar master, X-ray and CT imaging had some similar performances and manifested as acinar nodules, patchy and large fusion shadow, sometimes visible as air bronchial lesion, edge blurred. There was extensive consolidation of uniform density shadow when lung lesions progressed, with ＂Butterfly levy＂ as the typical sign. The rate of lesion detection was similar, the difference was not statistically significant. Chronic cardiogenic pulmonary edema showed more interstitial pulmonary edema, and chest X-ray and CT imaging showed pulmonary blood redistribu-tion, lung transmittance decreased, increased lung markings, weight gain, such as pleural thickening of interlobular septal lines with increased lung markings , thickened septal lines, numerous Kerley lines, peribronchial cuffing and lung parenchyma appeared GGO and other interstitial changes in the main pul-monary edema. The lesion signs inspection rate of pulmonary high resolution CT findings was higher than that of X-ray, the difference was statistically significant. Condusions For acute cardiogenic pulmonary edema, chest X-ray and CT findings are similar and the clinical diagnosis rate is the same, and chronic cardiogenic pulmonary edema, pulmonary CT examination can provide more diagnostic information and improve the clinical diagnosis rate.