摘要
目的通过分析不同类型及大小肺栓塞(PE)的碘灌注表现及碘基值的变化,评价CT能谱成像定量碘基物质图在PE诊断及病情评估中的价值。方法对73例临床疑似PE患者,先平扫,再行能谱增强扫描。选取其中阳性病例39例,将PE类型分为中心型、闭塞型、锐角附壁型、钝角附壁型及不规则型,观察不同类型及大小PE碘灌注的变化,测定栓塞区及对侧相同位置肺野的碘基值并进行比较,如双侧相同位置均有栓塞,则与邻近正常肺野比较。因不规则型PE发生较少,且多跨血管分布,只是统计栓塞数量,未进行碘基值测定。结果 39例经CT肺动脉血管成像(CTPA)证实为PE,共显示栓塞血管197支,栓塞类型为中心型63支,闭塞型58支,锐角附壁型39支,钝角附壁型26支,不规则型11支。闭塞型表现为全肺或肺叶灌注减低,PE血管供血区肺野平均碘基值为-0.45,对照区平均碘基值为8.15,差异有统计学意义(P<0.05)。中心型栓塞区平均碘基值为4.12,对照区平均碘基值为6.38,差异有统计学意义(P<0.05);锐角附壁型栓塞区平均碘基值为3.80,对照区平均碘基值为7.96,差异有统计学意义(P<0.05);中心型及锐角附壁型栓子大小超过血管直径的1/2表现为肺段或亚段灌注减低,栓子大小小于血管直径的1/2无明显灌注减低。钝角附壁型未见明显灌注减低,栓塞血管供血区肺野与对照区平均碘基值分别为7.48和7.73,差异无统计学意义。结论碘基物质图灌注改变与栓塞部位有良好的吻合性,能反映不同类型PE及栓子大小对供血区肺野碘灌注的影响,为PE诊断提供更多的形态及功能学信息。
Objective To analyze expressions of different types of pulmonary embolism（PE） and different size of emboli iodine-based substance mappings,and assess the value of ration-based iodine substance mappings of CT imaging on clinical diagnosis of PE and condition estimation.Methods 73 cases of suspected PE were collected,first with unenhanced and then enhanced CTA imaging through GE Discovery CT750 HD.39 positive cases among 73 were divided into different PE types： central,occluding,sharp-angled mural,obtuse-angled mural,and irregular.Iodine-based mappings of different types of PE were investigated.Emboli sizes of every type were recorded.Relationships between the severity of pulmonary emboli and reduced perfusion were analyzed.PE iodine value in blood supply areas were contrasted with that of the same contralateral lung field.Changes of iodine level were quantitatively investigated in the emboli in the same bilateral locations contrasted with that of the normal lung field.The figures of emboli of irregular type were recorded,but iodine value of irregular type,which was with low incidence and with multi-vascular distribution,was not calculated.Results 39 cases were confirmed as PE by CTPA with a total number of 197 embolized vessels： Embolized vessels of central type were 63,58 of occluding type,39 of sharp-angled mural type,28 of obtuse-angled mural type,and 11 of irregular type.Occluding type of PE,which was a reduced perfusion of manifestation in the whole lung or in the lob.There was statistical significance（P0.05） contrasting iodine mean value（-0.45） in the lung field of PE blood supply with that of contrasted area（8.15）.Central type of PE,there was statistical significance（P0.05） contrasting iodine mean value（4.12） in the lung field of PE blood supply with that of contrasted area（6.38）.There was statistical significance（P0.05） contrasting iodine mean value（3.80） of sharp-angled lung field of PE blood supply with that of contrasted area（7.96）.Emboli of central type and sharp-angled type exceeded half of vessels in diameter with reduced perfusion,while less than half of vessels with no obvious reduced perfusion.No obvious reduced perfusion was found in the obtuse-angled mural type of PE.There was no statistical significance contrasting iodine mean value（7.48） with that of contrasted area（7.73）.Few irregular types of PE were found,of which iodine value was not measured.Conclusion Perfusion changes of ration iodine-based substance mappings have a better consistency with embolized locations of CTPA,which determines the effects of different types of PE and diameters of emboli on pulmonary perfusion in the lung field of the blood supply areas,which provide more morphological and functional information for the diagnosis of PE.
出处
《安徽医科大学学报》
CAS
北大核心
2013年第9期1095-1098,共4页
Acta Universitatis Medicinalis Anhui
关键词
能谱CT
碘基图
肺栓塞
肺灌注
单能量
gemstone spectral CT
iodine mapping
pulmonary embolism
pulmonary perfusion
monochromatic energy
