双源CT对肺栓塞肺灌注识别对照观察

Comparative study of identification of pulmonary perfusion with dual source computed tomography in diagnosing pulmonary embolism

目的：探讨双源CT及其后处理技术在急性肺动脉栓塞诊断中应用价值。方法收集滨州医学院附属医院2011年10月至2013年5月收治20例可疑肺栓塞患者，进行双源CT扫描，应用3D软件、肺血管分析软件（lung vessels）、肺栓塞分析软件（PED）以及lung PBV软件对扫描图像进行分析，探索肺动脉成像（ CTPA）、lung vessels、PED对肺栓塞检出率差异有无统计学意义，筛选对肺段肺栓塞检出率最高的后处理方式，评价其与双源CT双能量肺灌注成像（ DEPI）对肺段肺栓塞的诊断的一致性。结果 CTPA、lung vessels及PED在肺动脉栓子的显示率均为30％，差异无统计学意义；CTPA、lung vessels及PED在叶动脉栓子的显示率分别为47.0％、49％及50％，差异无统计学意义；CTPA、lung vessels及PED在段动脉栓子的显示率分别为14.2％、19.7％及26.1％，两两比较差异均有统计学意义；CTPA、lung vessels及PED在亚段动脉栓子的显示率分别为3.7％、4.5％及7.0％， PED与CTPA、lung vessels之间对于亚段动脉栓子显示率差异有统计学意义。因此PED在段及段以下的肺栓塞诊断中临床价值最大。同时DEPI 图像对肺栓塞诊断的敏感性为85.7％，特异性为94.1％，kappa 系数为0.789， DEPI 图像与 PED 图像对肺栓塞的诊断具有较高的一致性。结论双源CT检查技术在肺栓塞诊断中有较高临床应用价值，PED在段及段以下动脉肺栓塞诊断中临床价值最大，DEPI能够显示肺栓塞的血流灌注异常，两者联合对肺栓塞的诊断具有较高临床价值。

Objective To explore the diagnostic value of dual source computed tomography （ CT ） in the diagnosing acute pulmonary embolism （ PE）.Methods A total of 20 cases with suspected PE were scanned by dual source CT and the data were analyzed with the software packages of conventional 3D, pulmonary embolism detection （ PED ） , lung vessels and lung PBV.The examination with the highest detection rate was used to screen for pulmonary segment of PE and verify the diagnostic consistency with dual-energy perfusion imaging （ DEPI） on pulmonary segment of PE.Results The detection rates for PE in pulmonary artery branches were all 30% for CTPA, lung vessels and PED.There were no statistical difference.The detection rates for PE in pulmonary lobar arteries were 47.0%, 49%and 50% for CTPA, lung vessels and PED.There were no statistical difference.The detection rates for PE in pulmonary segment arteries were 14.2%, 19.7%and 26.1%for CTPA, lung vessels and PED.Statistical differences existed among CTPA, lung vessels and PED.The detection rates for PE in pulmonary subsegment arteries were 3.7%, 4.5%and 7.0% for CTPA, lung vessels and PED.Statistical differences existed between PED , CTPA and lung vessels.No statistical difference existed between CTPA and lung vessels.PED had the higher clinical value on the diagnosis of PE of pulmonary segmental artery and inferior segmental artery .The sensitivity of DEPI for PE was 85.7%, specificity 94.1%and kappa 0.789.The diagnosis on PE of DEPI and PED image had a higher consistency.Conclusion The dual-energy scanning of dual source CT has higher practical values in the diagnosis of PE.And PED can visualize the pulmonary artery segment and a downstream segment of PE.Pulmonary perfusion imaging may show the perfusion abnormalities due to pulmonary blood flow changes.A combination of both increases the diagnostic rate of PE.