双源CT肺动脉造影在慢性肺栓塞中的应用价值

发布时间：2018-11-11 19:50

【摘要】：目的探讨双源CT肺动脉造影诊断慢性肺栓塞的影像特征及临床应用价值。方法选择75例行双源CT肺血管造影检查的患者,在轴位图像基础上,结合多平面重建(MPR)、最大密度投影(MIP)、容积再现(VR)等后处理技术,对CTPA图像进行综合分析。结果以CTPA诊断肺栓塞的标准确诊慢性肺栓塞26例,慢性肺栓塞的CTPA直接征象表现为:(1)肺动脉管腔内偏心性低密度充盈缺损,栓子与管壁形成钝角5例;(2)血管内壁不光整7例;(3)血管腔内边缘模糊的低密度充盈缺损3例;(4)管腔缩小5例;(5)管腔完全堵塞,无强化2例;(6)肺动脉分支减少4例。肺内间接征象表现为局部肺纹理稀疏纤细,或磨玻璃样改变,呈"马赛克"征、胸膜增厚、胸腔积液,两肺下叶盘状不张、不规则或楔形肺梗死、"肺少血"征、肺动脉高压、右室增大伴或不伴室间隔偏移、心包积液、支气管动脉扩张、同侧支气管扩张。结论双源CT肺动脉造影是诊断慢性肺栓塞的快速、无创的检查方法,根据直接征象能较准确地对慢性肺栓塞进行诊断,对临床治疗具有一定指导意义。
[Abstract]:Objective to investigate the imaging features and clinical value of dual-source CT pulmonary angiography in the diagnosis of chronic pulmonary embolism. Methods 75 cases of double source CT pulmonary angiography were selected. The CTPA images were analyzed synthetically on the basis of axial images, combined with the post-processing techniques such as multiplanar reconstruction of (MPR), maximum density projection (MIP), volume reconstruction (VR). Results 26 cases of chronic pulmonary embolism were diagnosed by CTPA. The direct signs of CTPA of chronic pulmonary embolism were as follows: (1) eccentric low-density filling defect in pulmonary artery and obtuse angle between embolus and wall in 5 cases; (2) Intravascular wall was not only complete in 7 cases; (3) low density filling defect was found in 3 cases; (4) lumen was reduced in 5 cases; (5) lumen was completely blocked without enhancement in 2 cases; and (6) pulmonary artery branch was decreased in 4 cases. The indirect signs in the lung were thin, or glass-like, with "mosaic" sign, pleural thickening, pleural effusion, disklike atelectasis, irregular or wedge-shaped pulmonary infarction, "pulmonary oligoblood" sign, pulmonary hypertension. Right ventricular enlargement with or without septal deviation pericardial effusion bronchial artery dilatation ipsilateral bronchiectasis. Conclusion Dual-source CT pulmonary angiography is a rapid and noninvasive method for the diagnosis of chronic pulmonary embolism. It can accurately diagnose chronic pulmonary embolism according to direct signs and has certain guiding significance for clinical treatment.
【作者单位】：新疆医科大学第一附属医院影像中心;
【基金】：新疆维吾尔自治区自然科学基金(2014211C057)
【分类号】：R563.5;R816.4

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