320排CT肺血管减影成像对急性肺栓塞诊断的初步临床研究

发布时间：2018-03-30 09:49

本文选题：体层摄影术　切入点：X线计算机　出处：《临床放射学杂志》2017年05期

【摘要】：目的探讨320排CT肺血管减影成像(DSCTPA)在肺栓塞(PE)诊断中的价值。方法 79例临床怀疑PE患者行DSCTPA,先进行CT平扫,后立即行CT肺动脉血管造影(CTPA),并将两组图像加载到Sure-Subtraction Lung软件进行处理,得到两组视图模式图像:Tissue模式为碘分布图融合肺动脉血管像(CTPA+碘图),Vessels模式为减影后肺动脉血管图像(CTPA+血管像)。由2名医师采用双盲法对2组图像和CTPA图像进行分析,肺动脉血管按肺动脉干,叶、段、亚段及以下,分别记录各患者栓子的数目与位置。研究图像显示方法诊断PE的敏感度、特异度、假阴性率及假阳性率。结果每个病例减影后处理平均耗时3.5 min,按标准测得血栓共326个,其中位于主干35个,叶肺动脉76个、段肺动脉133个、亚段及以下82个。CTPA图像、CTPA+血管像以及CTPA+碘图3组显示PE总栓子数的灵敏度、特异度及假阴性率和假阳性率分别为87.7%/91.7%/96.6%、82.9%/85.2%/83.7%、12.3%/8.3%/3.4%和17.1%/14.8%/16.3%。CTPA、CTPA+血管像、CTPA+碘分布图三种方法在各肺段栓子检出率为肺叶动脉96.1%/97.4%/98.7%,肺段动脉85.7%/92.5%/97.0%和肺亚段动脉及以下76.8%/81.7%/92.7%。结论DSCTPA成像一次减影可同时得到2组模式图像,有助于提高对周围肺动脉的显示能力和反映碘剂在肺实质的分布。CTPA图像结合碘分布图和血管减影图,不仅提高了亚段及以下段PE栓子的诊断检出率,而且可评价肺动脉栓塞后肺实质血流灌注的变化,为制定临床治疗方案提供参考。
[Abstract]:Objective to evaluate the value of DSCTPA in diagnosis of pulmonary embolism (PEI) with 320 slice CT subtraction imaging. Methods 79 patients with suspected PE were performed DSCTPA and CT plain scan was performed first. The two groups of images were loaded into Sure-Subtraction Lung software for processing. Two groups of view mode images: Tissue image: iodine distribution image fusion pulmonary artery image CTPA iodide image / Vessels model is subtraction pulmonary artery image. Two doctors used double blind method to analyze the two groups of images and CTPA images. The number and location of emboli in each patient were recorded according to the pulmonary artery trunk, lobes, segments, subsegments and below. The sensitivity and specificity of the image display method in the diagnosis of PE were studied. Results the average processing time of each case was 3.5 mins, 326 thrombus were measured according to the standard, including 35 main trunk, 76 lobar pulmonary arteries, 133 segmental pulmonary arteries, 35 main trunks, 76 lobar pulmonary arteries, 133 segmental pulmonary arteries, 35 main arteries, 76 lobar pulmonary arteries and 133 segmental pulmonary arteries. The sensitivity of total embolus number of PE was demonstrated by CTPA angiography and CTPA iodograms in 82 subsections and below. The specificity, false negative rate and false positive rate of CTPA were 87.7 / 91.796. 6 and 82.95.23.5%, respectively. They were involved in the level of 12.3 / 8.3 / 3.4% and 17.1 / 14.814.80.CTPA-CTPA CTPA vessel like CTPA iodine distribution. Conclusion the detectable rate of pulmonary embolus in each lung segment is 197.496.r98.798.7percent, the segmental artery 85.72.5r97.0% and the subsegmental artery 76.81.792. 77.70.Conclusion one subtraction of the pulmonary artery and the following 76.81.79.77.Conclusion one subtraction of the pulmonary artery and 76.81.792. 792. 7% of the subtraction of the pulmonary artery and the following 76.81.792. 7%. Conclusion one subtraction imaging of the pulmonary artery and the following 76.81.792. 7%. Conclusion one subtraction of the pulmonary artery and the following 76.81.792. 7%. Two sets of pattern images can be obtained at the same time. It is helpful to improve the display ability of peripheral pulmonary artery and reflect the distribution of iodine in pulmonary parenchyma. CTPA images combined with iodine distribution and subtraction angiography can not only improve the diagnostic rate of PE embolus in subsegmental and lower segments, but also improve the diagnosis rate of PE embolus. Furthermore, the changes of pulmonary parenchyma perfusion after pulmonary embolism can be evaluated.
【作者单位】：华中科技大学同济医学院附属协和医院放射科;
【基金】：湖北省自然科学基金资助项目(编号:2014CFB986)
【分类号】：R563.5;R816.41

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