多层螺旋CT肺动脉成像右心室参数评估急性肺栓塞的临床研究

Evaluation of Multiple-slice CT Pulmonary Angiography on Right Ventricular Parameters in Acute Pulmonary Embolism

目的探讨多层螺旋CT肺动脉成像(MSCTPA)右心室参数评估急性肺栓塞(APE)严重程度及评估早期死亡的临床价值。资料与方法回顾性分析2012年1月—2015年11月经非心电门控技术MSCTPA检查的患者260例,其中确诊为APE患者104例,正常者156例,按肺栓塞类型及预后分为混合型栓塞组66例(死亡25例,存活41例),周围型栓塞组36例,中央型栓塞组2例;应用CT后处理测量肺动脉主干及主动脉内径比值(PA/AO),右心室与左心室最大内径比(RVD/LVD)及四腔心层面右心室与左心室最大截面积比(RVA/LVA),横断面右心室与左心室之间的最大距离比值(RV-LD/LV-LD);比较混合型栓塞组、周围型栓塞组及正常组之间右心功能的参数。结果混合型栓塞组死亡患者右心室参数明显高于其他组(P<0.05);混合型栓塞组存活患者、周围型栓塞组及正常组RVD/LVD、RVA/LVA差异有统计学意义(P<0.05);周围型栓塞组与正常组在参数间差异无统计学意义(P>0.05)。3组间的PA/AO差异无统计学意义(P>0.05)。对混合型栓塞组死亡右心室参数进行受试者工作特性曲线分析,RVA/LVA评估APE早期死亡准确度最高,曲线下面积为0.881,敏感度为100.0%,特异度为73.2%。结论 MSCTPA右心室相关参数分析可对患者临床严重程度及评估早期死亡率进行预测,其中RVA/LVA的临床诊断准确率较高。

Purpose To evaluate the correlation between acute pulmonary embolism （APE） and right ventricular parameters by multi-slice spiral computed tomography pulmonary angiography （MSCTPA）, and assess the severity and mortality of patients with APE. Materials and Methods The clinical and MSCTPA image data of APE patients from January 2012 to November 2015 was analyzed retrospectively. All the patients were divided into three groups according to the pulmonary embolism type and clinical prognosis： 66 cases in mixed embolism group （25 cases of death, 41 cases of survival）： 36 cases in peripheral embolism group, 2 cases in centralembolism group. The CT post-processing software was used to measure thoracic aorta and main pulmonary artery inner diameter ratio （PA/AO）, right ventricular diameter to left ventricular diameter ratio （RVD/LVD）; right ventricular area to left ventricular area ratio （RVA/LVA） on axial four-chamber （4-CH） sections and the largest of maximum minor axis diameters on axial sections （RV/LV-LD）. The difference of CT related right ventricular parameters among the mixed embolism groups, peripheral embolism and normal groups was compared. Results Statistical difference was found in right ventricular parameters （RVD/LVD, RV-LD/LV-LD, RVA/LVA） in mixed embolism death patients compared with the patients in other three groups （P〈0.05）. There was significant difference of right ventricular parameters RVD/LVD, RVA/ LVA in mixed pulmonary embolism survival patients compared with patients in peripheral pulmonary embolism and normal groups （P〈0.05）, but there was no significant difference between peripheral APE patients and the control group in all RV and PA/AO parameters （P〉0.05）. According to the result of ROC curve in mixed type embolism death patients, RVA/LVA was the best indicator of predicting early death （AUC=0.881）, with 100.0% sensitivity and 73.2% specificity. Conclusion The right ventricular parameters by multi- slice CT pulmonary angiography can assess APE patient＇s condition and forecast their early mortality： and the clinical diagnosis accuracy of RVA/LVA is higher.