肺密度三维定量分析对急性肺栓塞的诊断价值

Diagnostic value of lung density evaluated by three-dimensional quantitative CT in acute pulmonary embolism

目的:探讨肺密度三维定量分析对急性肺栓塞的诊断价值。方法:回顾性收集行CT肺动脉造影(CTPA)检查者,证实为肺栓塞者195例,非肺栓塞者177例,两位影像科医生对CTPA进行阅读,记录栓子位置以及间接征象。结果:肺栓塞患者最常见的临床症状气促、咳嗽、胸痛分别占41%、39%、34%。53%的肺栓塞患者具有明确的危险因素。共发现412个栓子,间接征象在急性肺栓塞和非肺栓塞患者中出现率具有显著性差异(P<0.05),包括:马赛克征(20.3%vs 0%)、磨玻璃影(23.1%vs 9.4%)、肺实变(46.7%vs 18.8%)、肺不张(17.2%vs 2.8%)、胸腔积液(34.9%vs 23.3%)、胸膜肥厚粘连(77.8%vs 25.1%)。肺密度分析发现的肺野局限性低密度区在栓塞组和非栓塞组具有差别(47.2%vs 13.9%,P<0.05)。且局限性密度减低区与栓子位置的符合率为89.2%。结论:基于肺密度三维定量分析获得的局限性肺密度改变,结合肺栓塞患者的临床信息与CTPA其他间接征象对急性非栓塞诊断具有提示作用。

Objective To assess the value of lung density evaluated by three-dimensional quantitative CT in the diagnosis of acute pulmonary embolism(APE).Methods The clinical information of patients receiving CT pulmonary angiography(CTPA)was analyzed retrospectively.Atotal of 195 cases were confirmed as PE and 177 cases were confirmed as non-PE.The CTPAimages were analyzed by two radiologists,and the locations of emboli as well as indirect signs were recorded.Results The most common clinical symptoms in PE patients included shortness of breath,cough and chest pain,which accounted for 41%,39%and 34%,respectively.The 53%of PE patients had clear risk factors.A total of 412 emboli were found.Additionally,the occurrence rates of indirect signs were different in PE patients and non-PE patients(P<0.05),and the related indirect signs included mosaic attenuation(20.3%vs 0%),ground-glass opacity(23.1%vs 9.4%),lung consolidation(46.7%vs 18.8%),atelectasis(17.2%vs 2.8%),pleural effusion(34.9%vs 23.3%),pleural thickening and adhesion(77.8%vs 25.1%).The analysis on lung density showed that the incidences of local low-density area in PE group and non-PE group were 47.2%and 13.9%,respectively,with significant differences(P<0.05).The coincidence rate of local low-density area and the locations of emboli was 89.2%.Conclusion The local lung density deviations which are quantified on CT scan through three-dimensional quantitative analysis can be combined with the clinical information of PE patients and other indirect signs of CTPA to provide reference for the diagnosis of PE.