CTA诊断不同首发症状肺动脉栓塞的价值观察

Value of CTA in the Diagnosis of Pulmonary Embolism of Different First Symptoms

目的研究CT血管成像(CTA)在不同首发症状肺动脉栓塞(pulmonary embolism,PE)患者中的应用情况和诊断价值。方法选取2016年8月至2019年8月我院收治的疑似PE患者109例临床资料进行回顾性研究,根据首发症状分为胸部组71例和下肢组38例,所有患者均完成肺动脉和下肢CTA检查,分析两组图像特征并以临床确诊结果为金标准探讨CTA诊断价值。结果胸部组确诊为PE者54例,共栓塞血管209支,其中主肺动脉27支(12.92%),叶肺动脉51支(24.40%),段肺动脉78支(37.32%),亚段肺动脉53支(25.36%);下肢组最终确诊为PE者31例,共栓塞血管186支,其中主肺动脉15支(8.06%),叶肺动脉34支(18.28%),段肺动脉83支(44.62%),亚段肺动脉54支(29.03%);两组栓塞血管分布情况差异显著(Z=1.968,P=0.049),CTA对两组患者各段肺动脉栓塞情况检出率差异均无统计学意义(P>0.05);胸部组CTA发现DVT38例(70.37%),局部血栓13例(24.07%),广泛血栓25例(46.30%);下肢组CTA检测发现DVT30例(96.77%),局部血栓4例(12.90%),广泛血栓25例(83.87%);两组DVT发生率及分布情况均存在明显差异(P<0.05);CTA诊断首发肺部症状和下肢症状PE患者的灵敏度分别为94.44%和87.10%,特异度分别为88.24%和85.71%,准确率分别为92.96%和86.84%,一致性Kappa值0.810和0.625。结论不同首发症状PE患者肺动脉受累情况和下肢DVT血栓类型差异较大,采用CTA检查有利于明确栓塞原因、部位和数量等信息,为临床诊断和治疗提供参考依据。

Objective To study the application and diagnostic value of CT angiography(CTA)in patients with pulmonary embolism(PE)of different first symptoms.Methods A retrospective study was performed on clinical data of 109 suspected PE patients admitted to our hospital from August 2016 to August 2019.According to the first symptoms,the patients were divided into chest group(71 cases)and lower limb group(38 cases).All patients completed the pulmonary artery and lower extremity CTA.The image features were analyzed in the two groups,and the diagnostic value of CTA was explored by taking clinically confirmed results as golden standards.Results 54 patients were diagnosed as PE with 209 embolized vessels in chest group,including 27 branches(12.92%)of main pulmonary artery,51 branches(24.40%)of pulmonary lobar artery,78 branches(37.32%)of segmental pulmonary artery and 53 branches(25.36%)of subsegmental pulmonary artery.31 cases were diagnosed as PE with 186 embolized vessels in lower limb group,including 15 branches(8.06%)of main pulmonary artery,34 branches(18.28%)of pulmonary lobar artery,83 branches(44.62%)of segmental pulmonary artery and 54 branches(29.03%)of subsegmental pulmonary artery.There was significant difference in the distribution of embolized blood vessels between the two groups(Z=1.968,P=0.049),and there was no significant difference in the detection rate of pulmonary embolism in each part by CTA between the two groups(P>0.05).In chest group,CTA found that there were 38 cases of DVT(70.37%),13 cases of local thrombosis(24.07%)and 25 cases of extensive thrombosis(46.30%).In lower limb group,CTA found that there were 30 cases of DVT(96.77%),4 cases of local thrombosis(12.90%)and 25 cases of extensive thrombosis(83.87%).There were significant differences in the incidence rate and distribution of DVT between the two groups(P<0.05).The sensitivities of CTA in the diagnosis of patients with PE of first pulmonary symptoms and lower limb symptoms were 94.44%and 87.10%respectively,and the specificities were 88.24%and 85.71%respectively,and the accuracy rates were 92.96%and 86.84%respectively,and the consistency Kappa values were 0.810 and 0.625.Conclusion Pulmonary artery involvement and lower extremity DVT thrombosis are different in patients with PE of different first symptoms.CTA examination is helpful to clarify the cause,location and quantity of embolization,and provide reference for clinical diagnosis and treatment.