肺栓塞患者MR肺动脉造影检查表现特点及与其右心功能、预后评估的相关性研究

MR pulmonary angiography in patients with pulmonary embolism and its correlation with right heart function and prognosis

目的探究肺栓塞(pulmonary embolism,PE)患者MR肺动脉造影检查表现特点及与其右心功能、预后评估的相关性。材料与方法回顾性分析90例PE患者,根据病情和预后分为轻症PE组、重症PE组和预后佳组、预后不佳组。所有患者经行MR肺动脉造影检查,计算栓塞分数、灌注缺损分数和右、左心室短轴最大径比值(right and left ventricular short axis maximum diameter ratio,RV/LV)、肺动脉直径。比较不同严重程度患者的MR肺动脉造影的表现特点,以及不同组的栓塞分数、灌注缺损分数和RV/LV、肺动脉直径之间的差异,并分析其相关性,通过ROC曲线分析其对于预后的判断价值。结果轻症PE患者中,254段(69.0%)肺动脉分支的MR肺动脉造影表现为斑点状和斑片状充盈缺损,发生率显著高于重症PE组(P<0.05)。重症组MR肺动脉造影表现306段(95.6%)肺动脉分支为亚段或段充盈缺损,发生率显著高于轻症PE组(P<0.05)。重症PE组的栓塞分数和缺损分数、RV/LV、肺动脉直径均显著高于轻症PE组(P<0.05)。预后不佳组的栓塞分数和缺损分数均显著高于预后佳组(P<0.05)。栓塞分数和缺损分数、RV/LV、肺动脉直径之间呈现显著的正相关关系(P<0.05)。ROC曲线分析结果显示缺损分数和栓塞分数对于PE预后的曲线下面积分别为0.911(95%可信区间为0.625~0.966)、0.796(95%可信区间为0.800~1.000)。结论 MR肺动脉造影可以评价PE的严重程度,并且其对于右心功能和预后具有一定的诊断价值。

Objective:To investigate the characteristics of MR pulmonary angiography in patients with pulmonary embolism(PE)and its correlation with right heart function and prognosis assessment.Materials and Methods:A retrospective analysis was performed on 90 PE patients,who were divided into mild PE group,severe PE group,group with good prognosis and the group with poor prognosis according to their condition and prognosis.All patients underwent MR pulmonary angiography to calculate embolization score,perfusion defect score,right and left ventricular short axis maximum diameter ratio(RV/LV),and pulmonary artery diameter.To compare the features of MR pulmonary angiography in patients with different degrees of severity,as well as the differences in embolization score,perfusion defect score,RV/LV,and pulmonary artery diameter among different groups,and analyze their correlation,and analyze their prognostic value through ROC curve.Results:In mild PE patients,254 segments(69.0%)of pulmonary artery branches showed blotchy and patchy filling defects by MR pulmonary angiography,which was significantly higher than that in severe PE group(P<0.05).MR angiography showed 306 pulmonary artery branches(95.6%)as subsegmental or segmental filling defects in the severe group,with a significantly higher incidence than that in the mild group(P<0.05).The embolization score,defect score,RV/LV and pulmonary artery diameter of severe PE group were significantly higher than those of mild PE group(P<0.05).The embolization score and defect score of the group with poor prognosis were significantly higher than that of the group with good prognosis(P<0.05).There was a significant positive correlation between embolization score and defect score,RV/LV,and pulmonary artery diameter(P<0.05).ROC curve analysis showed that the area under the curve of defect score and embolization score for PE prognosis were 0.911(95%CI:0.625—0.966)and 0.796(95%CI:0.800—1.000),respectively.Conclusions:MR pulmonary angiography can be used to evaluate the severity of PE,and it has a certain diagnostic value for the function and prognosis of right heart.