多层螺旋CT肺动脉成像在诊断急诊肺动脉栓塞中的临床价值

The Clinical Value of Multi-slice Spiral CT Pulmonary Angiography in the Diagnosis of Emergency Pulmonary Embolism

目的分析多层螺旋CT肺动脉成像对急诊肺动脉栓塞的临床诊断应用与价值。方法收集72例行多层螺旋CT或MRI检查的肺动脉栓塞患者的病历与影像学资料,行多层螺旋CT肺动脉成像的患者为CT组(n=48),行常规MRI血管造影的患者为MRI组(n=24),分析两组的影像学资料,比较图像显示及诊断情况,并分析多层螺旋CT肺动脉成像的特点。结果与MRI组相比,CT组诊断准确性91.67%、敏感性70.83%、图像质量等级评分显著较高,扫描时间明显较短(P<0.05);多层螺旋CT检查诊断包括急性栓塞和慢性栓塞,栓塞部位以双侧居多;病变范围包括左右肺动脉远端、肺叶动脉、肺段以下动脉等;直接征象为肺动脉或分支内充盈缺损;间接征象表现为马赛克征、局限性肺纹理纤细或稀疏、肺动脉高压或扩张、胸腔或心包积液、部分肺段渗出或梗死。结论多层螺旋CT肺动脉成像在急诊肺动脉栓塞诊断中具有准确性、敏感性高,图像质量好等优点,且影像征象明显,对急诊肺动脉栓塞的临床诊疗有重要价值。

Objective To analyze the clinical value of multi-slice spiral CT pulmonary angiography in the diagnosis and treatment of emergency puhnonary embolism. Methods The medical records and intaging data of 72 patients with puhnonary embolismwho underwent multi-slice spiral CT or MRI examination were collected. Patients undergoing spiral CT pulmonary angiography were included in CT group （n=48） while patients undergoing routine MRI angiography were included in MRI group （n=24）. The imaging data of two groups were analyzed. The image display and diagnosis were compared, and the characteristics of multi-slice spiral CT pulmonaW angiography were analyzed. Results Compared with the MRI group, the diagnostic accuracy （91.67%）, sensitivity （70.83%） and image quality score in CT group were significantly higher, and the scanning time was shorter （P〈0.05）. Multislice spiral CT diagnosis included diagnosis of acute and chronic thrombosis, and the common site of embolism was bilateral. Extent of lesions included distal left and right pulmonary arteries, pulmonary lobar arteries, and pulmonary segment belowarteries, etc. The direct signs included filling defects ofpulmonaW artery or branches while indirect signs included mosaic sign, limited lung markings or sparse, pulmonary hypertension or expansion, pleural or pericardial effusion, and effusion or infarction of some pulmonaW segments. Conclusion Multislice spiral CT pulmonary angiography is accurate in the diagnosis of emergency pulmonary embolism, with high sensitivity and good image quality, and the imaging signs are obvious, which is of important value in clinical diagnosis and treatment of emergency pulmonary embolism.