256层螺旋CT肺动脉成像量化评价急性肺动脉栓塞患者右心室功能和肺动脉栓塞程度

Qualitative estimation of right ventricular function and pulmonary artery obstruction degree after acute pulmonary embolism with computed tomographic pulmonary angiography

目的应用256层螺旋CT肺动脉成像（CTPA）定量评价急性肺动脉栓塞（APE）患者右心室功能和肺动脉栓塞程度。方法选择经256层螺旋CTPA证实的APE患者75例,年龄25~80岁,平均（59.2±13.3）岁,其中男42例,女33例,采用CT肺动脉栓塞分数（obstruction scores,OS）评价APE程度,根据OS值将患者分为轻（n=18,OS〈30%）、中（n=25,OS=30%~50%）和重度（n=32,OS〈30%）,通过测量CT图像上右心室短轴最大直径（RVd）、左心室短轴最大直径（LVd）、右心室短轴与左心室短轴最大直径比率（RVd/LVd）、主肺动脉（MPA）、奇静脉及上腔静脉（SVC）直径评价右心室功能。同时比较3组右心室功能CT参数。结果 CT肺动脉栓塞程度和心血管参数之间有明显相关性（P〈0.01）,表现为在中、重度APE患者中RVd、RVd/LVd、主肺动脉直径、奇静脉直径及上腔静脉直径均较轻度APE患者高（P〈0.05）,而LVd值较轻度APE患者低,同时中度和重度APE患者之间这些参数差异也有统计学意义（P〈0.05）。结论应用CTPA得到的量化CT参数对评价APE患者右心室功能和APE程度是十分有力的工具,APE患者右心室功能障碍和APE程度密切相关。

Objective To qualitatively evaluate the right ventricular function and the pulmonary artery obstruction degree in patients of acute pulmonary embolism（APE）with computed tomographic pulmonary angiography（CTPA）.Methods Retrospective assessment was made in 75 APE patients,mean age（59.2±13.3）years;range 25-80years;33women.CT pulmonary angiography examinations were performed in the patients.CT pulmonary artery obstruction scores（OS）were used in the assessment of pulmonary arterial obstruction severity.All patients were divided into mild（n=18）,moderate（n=25）,or severe groups（n =32）according to OS 30%,30%-50%,≥50% respectively.Right ventricular function was assessed on CT in all patients by measuring right ventricular short axis diameter（RVd）,left ventricular short axis diameter（LVd）,RVd to LVd（RVd/LVd）ratio,main pulmonary artery,azygos vein,superior vena cava diameters.Also,these CT parameters for right ventricular function were compared among three groups.Results The correlation between CT pulmonary artery OS and cardiovascular parameters was significant（P〈0.01）.The cardiovascular parameters including RVd,RVd/LVd ratio,main pulmonary artery diameter,azygos vein diameter,superior vena cava diameter in patients with moderate and severe APE（OS 30%-50% and OS≥50%,respectively）were higher than those with mild APE（OS30%）（P〈0.05）.And LVd in patients with moderate and severe APE was lower than that with mild APE（P〈0.05）.In the meantime,comparison of cardiovascular parameters between patients with moderate and severe APE showed significant differences（P〈0.05）.Conclusion Quantitative CT parameters prove useful in evaluating the right ventricular function and the pulmonary artery obstruction degree in APE,and there was significant correlation between the right ventricular function and the pulmonary artery obstruction degree.