不同首发症状肺动脉栓塞CTA的表现及价值

The Value of CT Angiography Findings for Pulmonary Embolism of Different First Symptoms

目的探讨CT血管成像（CTA）对不同首发症状肺动脉栓塞（PE）的临床价值。方法回顾性分析PE患者107例的CTA资料,以胸部症状为首发症状76例为A组,下肢症状为首发症状31例为B组。观察PE是单侧还是双侧肺动脉受累,根据血栓累及肺动脉的部位分为主干型PE和分支型PE;下肢深静脉血栓形成（DVT）根据分布范围分为局部血栓和广泛血栓。采用χ^2检验分别比较A、B两组在累及单、双侧肺动脉的差异及主干型、分支型检出的差异;采用χ^2检验比较A、B两组在数字减影血管造影（DSA）检查中下肢DVT分布类型检出的差异。P〈0.05表示差异有统计学意义。结果 PE患者107例,CTA检查共发现栓子348个。A组76例,单侧肺动脉受累19例,双侧肺动脉受累57例;B组31例,单侧肺动脉受累15例,双侧肺动脉受累16例;两组患者单、双侧肺动脉受累情况差异有统计学意义（χ^2=5.55,P〈0.05）。A组患者主干型PE 64例,分支型PE 12例;B组患者主干型PE 19例,分支型PE 12例;两组的栓塞类型差异有统计学意义（χ^2=6.64,P〈0.05）。两组患者DSA检查共检出74例下肢DVT,DSA显示A组局部血栓11例,广泛血栓32例;B组局部血栓2例,广泛血栓29例;两组患者下肢DVT分布类型差异有统计学意义（χ^2=4.55,P〈0.05）。结论 CTA能准确诊断不同首发症状的PE及引起PE的下肢DVT,清楚地显示血栓的位置、范围,并且显示两组病例影像学上的差异,揭示了PE与DVT两者之间的相关关系,为临床制定治疗方案提供可靠依据。

Objective To assess the value of CT angiography（CTA） findings for pulmonary embolism of different first symptoms.Methods The CTA data of 107 patients with pulmonary embolism were retrospectively studied.The first symptoms of chest symptoms were 76 cases in group A,and the first symptoms of lower limb symptoms were 31 cases in group B.Unilateral or bilateral pulmonary arteries involvement was observed.According to the location of the thrombi involving the pulmonary arteries,thrombi could be divided into the trunk type and the branching type.According to the distribution of thrombi,deep venous thrombosis（DVT） could be divided into local thrombi and extensive thrombi.The differences of PE involving unilateral or bilateral pulmonary arteries and the trunk type or the branching type were compared between the two groups using χ^2 test,as well as the differences of the distribution types of DVT were detected by DSA between the two groups.P〈0.0 5 indicates the difference is statistically significant.Results There were 107 cases with Z = in pulmonary embolism.A total of 348 embolus were found in CTA examination.In group A,76 patients had unilateral pulmonary artery involvement in 19 patients and bilateral pulmonary artery involvement in 57 patients;31 patients in group B,15 patients with unilateral pulmonary artery involvement,and 16 patients with bilateral pulmonary artery involvement.There was a difference in the incidence of single pulmonary artery and bilateral pulmonary artery in the two groups.Statistical significance（χ^2= 5.55,P〈0.05）.In group A,there were 64 trunk-type PEs and 12 branch-type PEs.In group B,there were19 trunk-type PEs and 12 branch-type PEs.There was a statistically significant difference in the embolization patterns between the two groups（χ^2= 6.64,P〈0.05）.In the DSA examination of the two groups,a total of 74 cases of DVT were detected in the lower extremities.DSA showed 11 cases of local thrombus in group A and 32 cases of extensive thrombosis;2 cases of local thrombus in group B and 29 cases of extensive thrombosis;differences in distribution of DVT in the lower limbs between the two groups were statistically significant.Significance（χ^2= 4.55,P〈0.05）.Conclusion CTA can accurately diagnose PE with different first symptoms and PE DVT.It clearly shows the location and range of thrombus.It also shows the differences in imaging between the two groups and reveals the correlation between PE and DVT.Provide a reliable basis for clinical treatment planning.