慢性血栓栓塞性肺动脉高压的影像诊断与评估

Imaging diagnosis and evaluation of chronic thromboembolic pulmonary hypertension

慢性肺血栓栓塞性肺动脉高压(CTEPH)属于第四大类肺动脉高压。由于CTEPH患者的非特异性症状,因此CTEPH误诊率极高,当患者出现严重低氧血症及右心功能衰竭时患者预后极差,治疗难度明显增大。目前核素肺通气/灌注显像(V/Q)和计算机断层扫描肺血管成像(CTPA)是诊断CTEPH的重要无创性手段。V/Q显像肺灌注正常基本排除肺栓塞;V/Q显像提示肺栓塞可能后需通过CTPA显示的血管征象及肺实质征象判断是否为慢性肺栓塞、评估栓子累及部位及是否存在肺动脉高压,用于指导CTEPH治疗方案的选择和预后的评估。文章将对CTEPH的V/Q及CTPA影像表现、诊断、鉴别诊断与评估进行论述。

Chronic pulmonary thromboembolic pulmonary hypertension(CTEPH)belongs to the 4th category of pulmonary hypertension.Due to the non-specific symptoms of CTEPH patients,the misdiagnosis of CTEPH is extremely high,and its prognosis is extremely poor when patients have severe hypoxemia and right heart failure,and the difficulty of treatment is significantly increased.At present,radionuclide pulmonary ventilation/perfusion imaging(V/Q)and computed tomography of pulmonary angiography(CTPA)are important non-invasive method of diagnosing CTPEH.Normal pulmonary perfusion on V/Q basically excludes pulmonary embolism;V/Q imaging suggesting pulmonary embolism may be followed by vascular signs and pulmonary parenchymal signs on CTPA,which is used to determine whether it is chronic pulmonary embolism,to assess the site of emboli involvement,and to determine the presence of pulmonary hypertension,and these data are used to guide the treatment regimen and evaluation of prognosis of CTEPH.The V/Q and CTPA imaging findings,diagnosis,differential diagnosis and evaluation of CTEPH are discussed in this article.