256层螺旋CT肺动脉造影对肺动脉栓塞诊断价值.docVIP

256层螺旋CT肺动脉造影对肺动脉栓塞的诊断价值 　　【摘要】 目的 探讨256层螺旋CT肺动脉造影（CTPA）对肺动脉栓塞的诊断价值。方法 回顾性分析50例经256层螺旋CTPA确诊的肺动脉栓塞患者的临床资料。结果 50例肺动脉栓塞患者CTPA显示共累计720处肺动脉及分支。肺动脉栓塞的直接征象为肺动脉完全或部分重要缺损， 分为中心型、附壁环型、偏心型及闭塞型。累及肺动脉情况：左肺动脉主干80处， 右肺动脉主干69处， 肺叶动脉198处， 肺段动脉301处， 亚段动脉72处。间接征象CT表现为局限性肺纹理疏松、肺密度减低4例；肺梗死灶形成3例， 表现为肺实质内边缘模糊的三角形实变影， 基底位于胸膜， 尖端指向肺门， 部分表现为斑片状或大片状实变， 增强扫描时这些梗死灶不被强化为特点；肺动脉高压2例， 表现为中心肺动脉增宽， 中心肺动脉与外围肺动脉不对称；右心室增大1例；胸腔积液5例。结论 256层螺旋CT在临床应用中具有准确、快速、无创、图像清晰等优势， 可直观、立体地显示肺动脉栓塞的大小、分布及范围， 可成为检查肺动脉栓塞的首选方法， 值得在临床推广应用。 　　【关键词】 256层螺旋CT；肺动脉造影；诊断价值 　　DOI：10.14163/j.cnki.11-5547/r.2016.16.018 　　【Abstract】 Objective To investigate diagnostic value by 256-slice spiral CT pulmonary angiography （CTPA） for pulmonary artery embolism. Methods A retrospective analysis was made on clinical data of 50 pulmonary artery embolism patients， who were diagnosed by 256-slice spiral CTPA. Results There were totally 720 pulmonary arteries and branches with CTPA coloration in 50 pulmonary artery embolism patients. Direct signs of pulmonary artery embolism included complete or partial major defects， as center type， wall-attached circular type， eccentric type and block type. Involved pulmonary arteries included 80 left pulmonary arterial trunk cases， 69 right pulmonary arterial trunk cases， 198 pulmonary lobe artery cases， 301 pulmonary segment artery cases and 72 subsegment artery cases. Indirect signs were shown by CT as 4 cases with localized pulmonary texture osteoporosis and decreased lung density； 3 cases with pulmonary infarction lesions expressing obscure trilateral consolidation shadows in inward pulmonary parenchyma flange based on pleura and pointing hilus pulmonis， partially patchy or big consolidation as non-feature in enhancement scan； 2 cases with pulmonary hypertension expressing broadening and asymmetry central pulmonary artery； 1 case with right ventricular enlargement； 5 cases with pleural effusion. Conclusion 256-slice spiral CT contains advantages of accuracy， celerity， non-invasion， and image clarity