多层螺旋CT肺动脉成像右心室参数评估急性肺栓塞的临床研究

发布时间：2018-01-19 14:00

本文关键词： 肺栓塞急性病体层摄影术螺旋计算机肺动脉血管造影术心室功能右死亡　出处：《中国医学影像学杂志》2017年04期 　论文类型：期刊论文

【摘要】：目的探讨多层螺旋CT肺动脉成像(MSCTPA)右心室参数评估急性肺栓塞(APE)严重程度及评估早期死亡的临床价值。资料与方法回顾性分析2012年1月—2015年11月经非心电门控技术MSCTPA检查的患者260例,其中确诊为APE患者104例,正常者156例,按肺栓塞类型及预后分为混合型栓塞组66例(死亡25例,存活41例),周围型栓塞组36例,中央型栓塞组2例;应用CT后处理测量肺动脉主干及主动脉内径比值(PA/AO),右心室与左心室最大内径比(RVD/LVD)及四腔心层面右心室与左心室最大截面积比(RVA/LVA),横断面右心室与左心室之间的最大距离比值(RV-LD/LV-LD);比较混合型栓塞组、周围型栓塞组及正常组之间右心功能的参数。结果混合型栓塞组死亡患者右心室参数明显高于其他组(P0.05);混合型栓塞组存活患者、周围型栓塞组及正常组RVD/LVD、RVA/LVA差异有统计学意义(P0.05);周围型栓塞组与正常组在参数间差异无统计学意义(P0.05)。3组间的PA/AO差异无统计学意义(P0.05)。对混合型栓塞组死亡右心室参数进行受试者工作特性曲线分析,RVA/LVA评估APE早期死亡准确度最高,曲线下面积为0.881,敏感度为100.0%,特异度为73.2%。结论 MSCTPA右心室相关参数分析可对患者临床严重程度及评估早期死亡率进行预测,其中RVA/LVA的临床诊断准确率较高。
[Abstract]:Objective to evaluate the right ventricular parameters of MSCTPA with multi-slice spiral CT pulmonary angiography (MSCTPA) in assessing acute pulmonary embolism (APE). Data and methods from January 2012 to 2015, 260 patients with non-ECG gated MSCTPA were retrospectively analyzed. According to the type and prognosis of pulmonary embolism, 66 cases were divided into mixed embolism group (25 cases dead, 41 survival cases) and peripheral embolism group (36 cases). Central embolization group (2 cases); The ratio of pulmonary artery trunk to aortic diameter was measured by CT postprocessing. The RVD / LVD ratio and the RVA / LVA ratio of the right ventricle to the left ventricle at the four-chamber level. The ratio of maximum distance between right ventricle and left ventricle on cross section was RV-LDR / LV-LDV. Results the parameters of right ventricular function in the patients died in the mixed embolization group were significantly higher than those in the other groups (P 0.05). The RVD / LVDV / LVA of RVD / LVDV / LVA was significantly higher in the mixed embolization group than in the peripheral embolization group and the normal group (P 0.05). There was no significant difference in parameters between peripheral embolization group and normal group. There was no significant difference in PA/AO between group P0.053.There was no significant difference (P0.05). The parameters of the dead right ventricle in the mixed embolization group were analyzed by the operating characteristic curve. The accuracy of RVA/LVA in evaluating early death of APE was the highest, the area under the curve was 0. 881and the sensitivity was 100.0%. The specificity is 73.2. Conclusion the analysis of MSCTPA right ventricular parameters can predict the clinical severity and early mortality of patients. The accuracy of clinical diagnosis of RVA/LVA is high.
【作者单位】：重庆市江津区中心医院放射科;
【分类号】：R563.5;R816.4
【正文快照】： 急性肺栓塞(acute pulmonary embolism,APE)是临床较为常见的危重疾病,随着多层螺旋CT肺动脉成像(multi-slice spiral computed tomography pulmonary angiography,MSCTPA)的普及与应用,APE影像学诊断并不困难[1-3]。但是临床工作中需要影像科医师进一步评估病情及预后,以指导

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