不同CT成像技术对气虚血瘀证肺栓塞的对照观察

Comparative Observation of Different CT Imaging Techniques on Pulmonary Embolism with Qi Deficiency and Blood Stasis Syndrome

目的:寻求对肺栓塞准确诊断与经济实用的平衡点。方法:选取2018年1月至2020年12月期间共130例首发疑似气滞血瘀证肺栓塞(pulmonary embolosm, PE)的患者进行回顾性分析,随后对患者数据进行筛选,入选84例患者,分别采用双源双能量CT成像、宝石能谱CT成像和小剂量对比剂团注测试CT肺动脉造影成像等方法对疑似气滞血瘀证PE患者进行检查,进行气虚血瘀证及CT肺动脉造影的主、客观评价,探讨3种不同成像技术在PE诊断效能的差异。结果:(1)双源双能量成像与小剂量对比剂团注测试成像的主观评价。两组中CT肺动脉造影图像的PE诊断效能相近。在双源双能量成像所获的图像中,均有85%CT肺动脉造影的图像质量被医师1和医师2分别评为优秀(n=5)或良好(n=4)。在小剂量对比剂团注测试成像所获的图像中,均有88.9%CT肺动脉造影的图像质量被医师1和医师2分别评为优秀(n=5)或良好(n=4)。在整体图像质量方面,未发现双源双能量成像与小剂量对比剂团注测试成像之间存在统计学上的显著差异。(2)宝石能谱成像与小剂量对比剂团注测试成像的主观评价。两组中CT肺动脉造影图像的PE诊断效能相近。在宝石能谱成像所获的图像中,均有91.7%CT肺动脉造影的图像质量被医师3和医师4分别评为优秀(n=5)或良好(n=4)。在小剂量对比剂团注测试成像所获的图像中,分别有95.4%和95.5%CT肺动脉造影的图像质量被医师3和医师4分别评为优秀(n=5)或良好(n=4)。在整体图像质量方面,未发现宝石能谱成像与小剂量对比剂团注测试成像之间存在统计学上的显著差异。(3)3种不同CT肺动脉造影成像技术图像质量的客观评价。小剂量对比剂团注测试成像所获的肺动脉内CT值的均值及对比噪声比虽然均高于双源双能量成像、宝石能谱成像,但两种成像方式之间的差异没有统计学意义。两种成像方式所获的升主动脉内CT值及对比噪声比的差异具有统计学意义。结论:在快速筛查可疑PE患者时,小剂量对比剂团注测试成像所获得的CT肺动脉造影图像完全能够胜任临床的诊疗需求,可以将其作为临床筛查PE的首选方法,在必要时可以加用多参数成像以获得更多数据来辅助诊断,是实现PE准确诊断与经济实用的平衡点的最优解。

Objective: To seek the balance between accurate diagnosis and economic application of pulmonary embolism(PE).Methods: A total of 130 patients with suspected PE of qi stagnation and blood stasis syndrome from January 2018 to December 2020 were selected for retrospective analysis, and then the patient data were screened.84 patients were selected to examine PE patients with suspected qi stagnation and blood stasis syndrome by dual source and dual energy CT imaging, gem energy spectrum CT imaging and low-dose contrast agent bolus injection test CT pulmonary angiography.The subjective and objective evaluation of qi deficiency and blood stasis syndrome and CT pulmonary angiography were carried out to explore the differences of the diagnostic efficacy of three different imaging techniques in PE.Results:(1)Subjective evaluation of dual source dual energy imaging and low-dose contrast agent bolus test imaging.The diagnostic efficacy of CT pulmonary angiography in PE was similar between the two groups.Among the images obtained by dual source dual energy imaging, 85% of the image quality of CT pulmonary angiography was rated excellent(n=5) or good(n=4) by physician 1 and physician 2 respectively.Among the images obtained by low-dose contrast agent bolus injection test imaging, 88.9% of the image quality of CT pulmonary angiography was rated excellent(n=5) or good(n=4) by physician 1 and physician 2 respectively.In terms of overall image quality, no statistically significant difference was found between dual source dual energy imaging and low-dose contrast agent bolus test imaging.(2)Subjective evaluation of gem energy spectrum imaging and low-dose contrast agent mass injection test imaging.The diagnostic efficacy of CT pulmonary angiography in PE was similar between the two groups.Among the images obtained by gem energy spectrum imaging, 91.7% of the image quality of CT pulmonary angiography was rated excellent(n=5) or good(n=4) by doctor 3 and doctor 4 respectively.95.4% and 95.5% of the images obtained by low-dose contrast bolus injection test imaging were rated excellent(n=5) or good(n=4) by physician 3 and physician 4 respectively.In terms of overall image quality, no statistically significant difference was found between gem energy spectrum imaging and low-dose contrast agent bolus test imaging.(3)Objective evaluation of image quality of three different CT pulmonary angiography techniques.Although the mean value of CT and CNR in pulmonary artery obtained by low-dose contrast agent bolus injection test imaging are higher than that of dual source dual energy imaging/gem energy spectrum imaging, the difference between the two imaging methods is not statistically significant.The difference of CT value and CNR in ascending aorta obtained by the two imaging methods was statistically significant.Conclusion: In the rapid screening of suspected PE patients, the CT pulmonary angiography images obtained by low-dose contrast agent bolus test imaging can fully meet the clinical diagnosis and treatment needs.It can be used as the preferred method for clinical screening of PE.When necessary, multi parameter imaging can be added to obtain more data to assist the diagnosis.It is the optimal solution to realize the balance between accurate diagnosis and economic and practical diagnosis of PE.