能谱CT在肺栓塞小栓子检出中的临床应用

Clinical Application of Gemstone Spectral CT in Pulmonary Embolism Detection of Small Emboli

目的:探讨宝石能谱CT能谱曲线及碘基物质图在肺栓塞小栓子诊断中的价值。材料与方法:回顾性分析30例经宝石能谱CT及临床确诊为肺动脉栓塞病人的影像资料和临床资料,由2名中级职称以上的影像医师先后分别用单纯CT肺动脉造影(CTPA)方法和CTPA+能谱方法对上述30例患者进行分析,记录栓子数量及发生部位。然后利用GSI浏览器(GSI Viewer)得到栓塞区及对侧相同部位正常的碘基值和能谱曲线,若双侧同部位肺组织均有栓塞,则取邻近区域正常肺组织进行对比。通过配对t检验观察碘基值的两组结果、能谱曲线斜率的两组结果的差异性。结果:30例肺栓塞患者,单纯CTPA方法和CTPA+能谱分别检出栓塞肺动脉53、62支,叶级肺动脉6、6支,段级肺动脉16、16支,亚段级肺动脉30、33支,亚段以下级肺动脉1、7支。栓塞区的碘基值为2.55±3.12,对照组的碘基值为15.72±4.67,二者差异有统计学意义(P<0.05)。栓塞区的能谱曲线斜率为0.15±0.27,对照组的能谱曲线斜率为1.07±0.31,二者差异有统计学意义(P<0.05)。结论:CTPA+能谱方法对于肺动脉栓塞支数的检出率高于单纯CTPA方法,肺栓塞区域的碘基值和能谱曲线斜率低于对侧同部位或邻近区域正常肺组织的碘基值和能谱曲线斜率,间接反映了肺部血流灌注情况,这对肺栓塞小栓子的检出提供了更多的指标,具有重要的临床应用价值。

Purpose： To discuss the value of spectrum curve and iodine-based material imaging in the diagnosis of pulmonary embolism small emboli. Materials and Methods： Retrospective analysis 30 eases of pulmonary embolism patients image data and clinical data with Gemstone spectral CT and clinical diagnosis, the image of 2 intermediate title more physician successively record the quantity and location of embolus with pure CT pulmonary angiography （ CTPA ） method and CTPA ＋ spectral method to analyze the above 30 patients. Then use The GSI Viewer software by embolization area and the side of the same parts of normal iodine content and spectrum curve, take a neighboring area comparing with normal lung tissue, if bilateral lung tissue with parts have embolism. By paired t test to observe the iodine content value of the slope of the two sets of results, the energy spectrum curve of the differences between two sets of results. Results： Among the 30 patients with pulmonary embolism, pure CTPA method and CTPA ＋ spectral method can detect embolism pulmonary 53, 62, leaf pulmonary artery 6, 6, period of pulmonary artery 16, 16, the period of pulmonary artery 30, 33, and paragraphs to lower pulmonary artery 1,7 respectively. Embolization of iodine content was 2. 55± 3.12, the control of iodine content was 15.72 ± 4. 67, the difference was statistically significant （ P 〈 0. 05 ）. Embolization of spectrum curve slope is 0. 15 ± 0. 27 mm, the control spectrum curve of the slope was 1.07 ± 0. 31, the difference was statistically significant（ P 〈 0.05）. Conclusion： CTPA ＋ energy spectrum method for pulmonary embolism count detection rate higher than the troditional pure CTPA method, and iodine content of pulmonary embolism area with energy spectrum curve slope is lower than the eontralateral area or the adjacent area of normal lung tissue iodine content and spectrum curve slope, which is indirectly reflected the pulmonary blood flow perfu- sion, and more indicators for the detection of small pulmonary embolism embolus are provided, as is important for clinical value.