【摘要】：目的探討雙源CT肺動(dòng)脈造影診斷慢性肺栓塞的影像特征及臨床應(yīng)用價(jià)值。方法選擇75例行雙源CT肺血管造影檢查的患者,在軸位圖像基礎(chǔ)上,結(jié)合多平面重建(MPR)、最大密度投影(MIP)、容積再現(xiàn)(VR)等后處理技術(shù),對(duì)CTPA圖像進(jìn)行綜合分析。結(jié)果以CTPA診斷肺栓塞的標(biāo)準(zhǔn)確診慢性肺栓塞26例,慢性肺栓塞的CTPA直接征象表現(xiàn)為:(1)肺動(dòng)脈管腔內(nèi)偏心性低密度充盈缺損,栓子與管壁形成鈍角5例;(2)血管內(nèi)壁不光整7例;(3)血管腔內(nèi)邊緣模糊的低密度充盈缺損3例;(4)管腔縮小5例;(5)管腔完全堵塞,無(wú)強(qiáng)化2例;(6)肺動(dòng)脈分支減少4例。肺內(nèi)間接征象表現(xiàn)為局部肺紋理稀疏纖細(xì),或磨玻璃樣改變,呈"馬賽克"征、胸膜增厚、胸腔積液,兩肺下葉盤(pán)狀不張、不規(guī)則或楔形肺梗死、"肺少血"征、肺動(dòng)脈高壓、右室增大伴或不伴室間隔偏移、心包積液、支氣管動(dòng)脈擴(kuò)張、同側(cè)支氣管擴(kuò)張。結(jié)論雙源CT肺動(dòng)脈造影是診斷慢性肺栓塞的快速、無(wú)創(chuàng)的檢查方法,根據(jù)直接征象能較準(zhǔn)確地對(duì)慢性肺栓塞進(jìn)行診斷,對(duì)臨床治療具有一定指導(dǎo)意義。
[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.
【作者單位】： 新疆醫(yī)科大學(xué)第一附屬醫(yī)院影像中心;
【基金】：新疆維吾爾自治區(qū)自然科學(xué)基金(2014211C057)
【分類(lèi)號(hào)】：R563.5;R816.4

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