超声及64排CT在肺动脉栓塞诊断中应用.docVIP

超声及64排CT在肺动脉栓塞诊断中应用【摘要】 目的 探讨超声及64排螺旋CT血管成像在肺动脉栓塞(PE)诊断中的临床应用。方法 对56例临床怀疑PE的患者进行多普勒超声及64排CT血管造影检查，通过最大密度投影(MIP)、多平面重组(MPR)及容积再现(VR)等后处理技术进行肺动脉三维成像。结果 56例患者中肺动脉栓塞34例，PE病例CT主要表现为完全性或部分性充盈缺损。超声心动图诊断PE的直接征象(肺动脉血栓)3例，间接征象20例，无异常变化33例。结论 超声检查发现肺动脉栓塞直接或间接征象可以明确诊断或疑似诊断，而多排螺旋CT是一种有效、准确、无创性诊断PE的检查方法。? 【关键词】 超声；X线计算机；体层摄影术；肺栓塞 Application of ultrasound and 64-slice CT in the diagnosis of pulmonary embolism ZHANG Xiu-li,CHEN Xiao-xu,LI Xue-jin,et al. Physical Examination Center of Daqing Oilfield General Hospital,Daqing 163001,China 【Abstract】 Objective To evaluate the clinical application value of Ultrasound and 64-slice CT in the diagnosis of pulmonary embolism(PE).Methods 56 patients suspected of PE were examined with Ultrasound and 64-slice CT.There-dimensional imaging methods were used in every case.Results 34 patients with PE were examined by 64-slice CT pulmonary angiography. Most cases showed complete or partial filling defect. The echocardiogram diagnoses PE of the direct sign(pulmonary artery thrombus) were in 3 cases,the indirect sign in 20 cases,no abnormal changes in 33 cases.Conclusion PE can be diagnosed or prediagnosed with direct or indirect signs detected by ultrasound,however 64-slice CT is an effective and noninvasive method for the diagnosis of pulmonary embolism.? 【Key words】 Ultrasound；X-ray computed;Tomography;Pulmonary embolism ? 作者单位：163001大庆油田总医院体检中心 肺动脉栓塞是血栓或其他异物嵌塞于肺动脉管腔内，栓子可以是血栓，脂肪栓，瘤栓或气栓等。肺动脉栓塞可引起呼吸和循环障碍，严重时可导致休克和死亡，早期及时诊断对于患者预后极为重要。本文探讨超声及64排CT在肺动脉栓塞诊断中的应用价值。? 1 资料与方法? 1.1 一般资料 56例临床疑有肺动脉栓塞病变的患者，男32例，女24例，年龄为46～78岁，平均年龄69岁。主要临床表现为胸痛、胸闷、呼吸困难。? 1.2 影像检查方法? 1.2.1 CT检查法 采用我院2006年3月引进的荷兰Philips公司的64排CT扫描机(Philips BrillianceTM 64 CT)，扫描范围从胸廓入口至肺底。扫描参数：120 kV 300 mAs，层厚1 mm，层间隔0.8 mm,collimation：64 0.625,Rotation time:0.75s,Pintch:0.703，FOV:350,Matrix:512 512,Resolution:standard。造影剂静脉注射流率4.0 ml／s。利用Bolus Tracking软件1 s间隔轴扫监视肺动脉干水平的造影剂浓度变化，达到120 HU时触发扫描。触发扫描延迟时间范围9～15 s，整个扫描时间约5 s，将薄层图象输入EBW(Extended Brillian