以胸部首发症状的肺动脉血栓患者CTA表现及临床应用价值分析

CTA Performance of PE Patients with First Symptom of Chest and Its Clinical Application Value

目的分析以胸部首发症状的PE患者CTA表现及临床应用价值。方法回顾性分析我院2017年4月至2019年8月收治的65例PE患者的临床资料,比较不同医师评价CTA成像质量及上腔静脉伪影评分的一致性,分析CTA显示肺动脉受累及PE分型情况。结果通过两位医师对CTA肺动脉成像质量及上腔静脉伪影进行评价,评分结果经Kappa检验显示两位医师评分结果高度一致,Kappa均大于0.81,一致性较好。肺动脉单侧受累患者14例,双侧46例;栓塞分型:主干型53例,分支型7例,与DSA检查比较,差异无统计学意义(P>0.05);肺动脉内完全充盈缺损41例,部分充盈缺损24例。部分充盈缺损患者中8例可见轨道征;5例可见蜂窝状;6例附壁充盈缺损,呈“新月形”或“环形”;5例充盈缺损部分附壁,内缘凸向管腔。结论 CTA检查可清楚显示以胸部首发症状的PE患者的影像学特点,在早期诊断PE上具有一定的价值,结合患者临床资料可有效提高诊断准确率,值得临床推广。

Objective To analyze the CTA performance of PE patients with first symptom of chest and its clinical application value.Methods The clinical data of 65 patients with PE admitted from April 2017 to August 2019 in our hospital were retrospectively analyzed.The consistency in CTA imaging quality and artifact scores of superior vena cava appraised by different physicians was compared.The involvement of pulmonary artery showed by CTA and PE classification were analyzed.Results The quality of CTA pulmonary artery imaging and artifact of superior vena cava were evaluated by two physicians.The Kappa test showed that the results of the two doctors were highly consistent,Kappa was>0.81,and the consistency was good.There were 14 patients with unilateral involvement of the pulmonary artery and 46 patients with bilateral involvement of the pulmonary artery.The classification of embolization:there were 53 cases trunk type and 7 cases branch type.Compared with DSA,the difference was not statistically significant(P>0.05).There were 41 cases with complete filling defect in the pulmonary artery and 24 cases with partial filling defect.Among the patients with partial filling defects,8 cases showed orbital signs,5 cases showed honeycomb shape,6 cases had mural filling defects,which were crescent-shaped or ring-shaped,and 5 cases had mural filling defects partly,and inner edge was convex toward the lumen.Conclusion CTA examination can clearly show the imaging characteristics of PE patients with first symptom of chest,and has certain value in early diagnosis of PE.The combination of clinical data of patients can effectively improve the diagnostic accuracy.It is worthy of clinical promotion.