【摘要】 目的 探讨双源CT肺动脉造影(CTPA)对肺段和亚段肺动脉栓塞(PE)的诊断价值。方法 对临床疑诊PE患者行CTPA,对14例首诊外周PE及15例首诊阴性的患者进行回顾性分析,由2位心血管病影像诊断医师在后处理工作站独立对原始薄层图像进行多平面重组(MPR)和最大密度投影法重组(MIP)以观察栓子分布情况。根据诊断标准,对肺段、亚段动脉的检出及栓子评价按节段记录为阳性、阴性、可疑及未显示。采用配对计数χ~2检验及k系数检验分析两者的诊断差异及吻合度。结果 15例首诊阴性的患者再次检出2例外周PE,16例外周PE均能清楚显示肺段动脉,对亚段肺动脉显示率为90.39%。2位医师对肺段和亚段动脉栓子检出评价差异无统计学意义(χ~2=0.333和3.325,P均>0.05),对段和亚段动脉栓子等级评价具有较好的吻合度(k=0.92和k=0.81)。结论 双源CTPA能清楚地显示外周肺动脉,不同观察者对外周PE的诊断评价具有较好一致性,因而对外周PE具有较好的诊断价值。更多还原

【Abstract】 Objective To evaluate the diagnostic value in peripheral pulmonary embolism(PE) by using dual-source CT pulmonary angiography(CTPA).Methods CTPA was performed for patients with clinical suspect of PE.Fourteen cases were first diagnosed as peripheral PE(with PE at segmental-or-below levels) and 15 cases were diagnosed as negative.Their CTA data were retrospectively analyzed.The raw CTA data were reformatted and interpreted by two cardiovascular radiologists independently with postprocessing technique of multiplanar reconstruction(MPR) and maxium intensive projection(MIP).According to the reference standard,the evaluation of the segmental and subsegmental pulmonary artery and peripheral PE was set as positive,negative,suspected and non-displayed.Diagnostic difference and goodness of fit between the two radiologists were assessed by using matchedpairs χ~2 test and kappa test.Results Among the 15 cases who were first diagnosed as negative of PE,2 were detected peripheral PE with consentaneous.All the segmental arteries of the 16 peripheral PE cases were showed clearly.The display rate of the subsegmental arteries was 90.39 %,No significant difference were found in the detection of segmental and subsegmental PE between the two readers(χ~2=0.333,P=0.954 and χ~2=3.325,P=0.767).The goodness of fit was quite good in the evaluation of segmental and subsegmental PE(k=0.92 and k=0.81).Conclusion The segmental and subsegmental pulmonary artery can be clearly displayed by dual-source CTPA.The consistency of the peripheral PE were confirmed quite good in different readers.Therefore,CTPA can be used in the diagnosis of peripheral pulmonary embolism.更多还原