急性肺动脉栓塞病情变化对CTPA与DSA诊断一致性的影响及分析

A Consistent Study of CTPA and DSA on Changes of Acute Pulmonary Thromboembolism

目的探讨急性肺动脉血栓栓塞(PTE)患者病情变化对CT肺动脉造影(CTPA)与数字减影血管造影(DSA)诊断一致性的影响及其机制。方法搜集行介入手术治疗且术前及术后均行CTPA检查的PTE患者29例。以DSA为标准评价CTPA对PTE的诊断能力。结果 29例PTE患者的同期CTPA与DSA评分差异无统计学意义;21例次出现评分差异的DSA评分值明显高于37例次评分一致病例,且主要集中分布在评分≥9分的区间。结论 PTE患者病情的不断急剧变化可能是导致CTPA与DSA检查影像差异且不可避免的重要因素,在排除影响CTPA图像质量可能因素的情况下,CTPA与DSA检查影像差异可能是PTE病程中不同时间窗内病情变化的影像学表现,不应该被完全认定为漏诊或误诊。

Objective To investigate the consistent effect and mechanism of pulmonary artery CT angiography（CTPA）and DSA on changes of pulmonary thromboembolism（PTE）.Methods CTPA was performed in 29 patients with PTE before and after interventional operation.The diagnostic ability of CTPA for pulmonary embolism is evaluated according to the pulmonary arteriography（DSA PA）.Results There were no significant differences of the scores between CTPA and DSA in 29 patients with PTE,but the obvious differences of scores before and after interventional operation.The DSA score values of 21 cases with differences in scores were significantly higher than 37 cases with no differences in scores,which mainly distributed in the interval of more than 9 score.Conclusion Rapidly change of PTE disease may be an important and inevitable factor leading to difference of CTPA and DSA.In the exclusion of the possible effects of CTPA image quality,CTPA and DSA image difference may be the imaging manifestations of different time window in the course of PTE disease,which should not be recognized as misdiagnosis.