宝石能谱CT在诊断外周肺动脉不典型栓塞中的应用

Application of gemstone spectral computed tomography in the diagnosis of peripheral pulmonary artery atypical embolism

目的分析宝石能谱计算机X线断层扫描(computed tomography,CT)在诊断外周肺动脉不典型栓塞的应用价值。方法回顾性分析沈阳军区总医院2017-01至2017-12确诊的25例肺动脉栓塞(pulmonary embolism,PE)患者的临床资料。所有患者均行宝石能谱计算机断层摄影肺血管造影术(computed tomographic pulmonary angiography,CTPA)检查,应用能谱分析软件对结果进行分析;分别选取外周肺动脉不典型栓子、肺动脉主干栓子、肺血管壁及肺血管腔四处感兴趣区(region of interest,ROI),记作"ROI_1、ROI_2、ROI_3及ROI_4",测算四个ROI的曲线斜率及碘基物质图分布特征。结果 (1)25例中,9例为肺动脉主干栓塞,10例为肺动脉主干及外周肺动脉同时栓塞,6例为外周肺动脉栓塞(peripheral pulmonary embolism,PPE)。(2)四处RO_I的能谱曲线斜率分别为(1.17±0.92)、(1.75±0.51)、(2.99±0.46)及(14.81±2.36);ROI1曲线走形、斜率与ROI_3、ROI_4存在明显差异(P<0.05);ROI_1、ROI_2的曲线走形、斜率差异无统计学意义。(3)ROI_1、ROI_2在碘基物质图上存在明显异常灌注,而ROI_3、ROI_4在碘基物质图上的结果为阴性。结论宝石能谱CT多参数分析,可有效鉴别诊断外周动脉不典型栓塞并提高其阳性确诊率,为临床早期诊治提供帮助。

Objective The objective of this study was to analyze the application value of gemstone spectral computed tomography（CT） in the diagnosis of peripheral pulmonary artery atypical embolism. Methods A total of 25 patients diagnosed as pulmonary embolism（PE） in General Hospital of Shengyang Military Region from January 2017 to December 2017 were retrospectively analyzed. All patients were examined using gemstone spectral computed tomographic pulmonary angiography（CTPA）, and the results were analyzed by spectrum analysis software. The four regions of interest（ROI）, i.e., peripheral pulmonary artery atypical embolus, pulmonary artery embolus, pulmonary vascular wall and pulmonary vascular cavity, were selected and recorded as ＂ROI1, ROI2, ROI3, ROI4＂. The slope curves of four ROIs and the distribution characteristics of iodine based substance map were calculated. Results（1） Of the 25 cases, 9 cases were embolized in the main pulmonary artery, 10 cases were embolized simultaneously in the main pulmonary artery and peripheral pulmonary artery, and 6 cases were peripheral pulmonary embolization（PPE）.（2） Energy spectrum curve slope of the four ROIs were（1.17±0.92）,（1.75±0.51）,（2.99±0.46） and（14.81±2.36） respectively. The curve shape and slope of ROI1 were significantly different from ROI3 and ROI4（P〈0.05）. There was no statistical difference in the curve shape and slope between the ROI1 and ROI2.（3） On the iodine based substance map, ROI1 and ROI2 had obvious abnormal perfusion, and the results of ROI3 and ROI4 were negative. Conclusions Multi-parameter analysis of gemstone spectral CT can effectively identify peripheral pulmonary artery atypical embolism and improve the positive diagnosis rate, so as to provide reference for early diagnosis and treatment.