肺动脉CT血管成像对肺栓塞的诊断价值

Application Value of lung Computer Tomography Angiography in Diagnosing Pulmonary Embolism

【目的】探讨肺动脉CT血管成像（CTA）在肺栓塞（PE）诊断中的临床应用价值。【方法】回顾性分析2013年1月至2015年12月本院收治的67例疑似PE患者的肺动脉CTA检查资料，以病理学诊断结果为依据，对67例疑似PE患者的临床表现、病变的CTA影像特征、误诊情况及其栓子特点进行综合分析。【结果】67例疑似PE患者，经肺动脉CTA诊断出PE患者63例，经病理学确诊62例PE患者，误诊率仅为1．58％，不存在漏诊的情况。62例PE患者，其中9例为肺动脉主干、叶、段肺动脉多部位栓塞，累及主肺动脉12例、右肺动脉19例、左肺动脉22例。通过肺动脉CTA扫描62例PE患者共检查出78个栓子，包括59个血栓，脂肪栓11个，空气拴5个，其他3个。血栓来源广泛，其中来至于盆腔及下肢深静脉血栓分别为24个和19个。【结论】肺动脉CTA在诊断PE时不仅可直接显示出栓子的位置、形状、病程时间及其间接征象，同时还可诊断同PE具有相似病症的疾病，误诊和漏诊率低，且可协助寻找栓子的来源，为患者的临床溶栓治疗提供依据。

[Objective]To investigate the application value of lung computer tomography angiography （CTA） in the diagnosis of pulmonary embolism （PE）. [Methods]Clinical data and CTA data of 67 cases of suspected PE patients in our hospital received during December 2013 to December 2015 were retrospectively analyzed. Comprehensive analysis of CTA imaging features, clinical manifestations, misdiagnosis, and embolus characteristics of pulmonary embolism were conducted based on the pathological examination. [Results] There were 67 cases of suspected PE, in which 63 cases of PE were diagnosed by CTA and 62 PE patients were diagnosed pathologically. So the misdiagnosis rate of PE by CTA was only 1.58%, and there were no missed diagnosis. Among the 62 cases of patients with PE, 9 cases were of multi-site embolism in pulmonary trunk, leaves, segment pulmonary, 12 cases involving the main pulmonary artery, 34 cases involving the right pulmonary artery, and 22 cases involving the left pulmonary artery. There were 78 emboli total among the 62 cases, include thrombosis （59）, fat plugs （11）, air plugs （5） and others （3）. Thrombosis came from different places, such as pelvic thrombosis （24） and lower extremity deep venous thrombosis （19）. [Conclusion]CTA in the diagnosis of pulmonary embolism not only can display the position, shape, duration time, and indirect signs of embolus, but also can diagnose a disease that shows similar symptoms to PE. CTA is an intuitive and reliable method for diagnosing PE that has a low rate of misdiagnoses and missed diagnoses. It also can help find the source of emboli, which may provide the basis for clinical thrombolytic therapy.