【摘要】 目的探讨HDCT能谱成像在肺栓塞诊断中的临床诊断价值。方法 124例怀疑肺栓塞的患者行HDCT能谱增强扫描,可获得常规CT肺血管造影图像(CTPA)及碘基物质图像。观察肺动脉内有无栓子,记录栓子的位置、数目;分析碘基物质图的影像学表现,记录肺内灌注降低区的位置及数目,并测量肺内灌注降低区的碘含量,同时测量同层面或者邻近层面正常肺实质的碘含量。7例患者治疗后随访,比较碘基物质图上灌注降低区治疗前后的碘含量变化。不同碘含量比较采用独立样本t检验。结果明确诊断肺动脉栓塞34例,共345个栓子,其中肺主干26个(7.54%),肺叶70个(20.29%),肺段171个(49.57%),亚段78个(22.61%),肺内灌注降低区133处。正常肺实质区〔(23.86±8.99)100μg/L〕与灌注降低区〔(5.07±4.74)100μg/L〕碘基物质图碘含量差异有统计学意义(t=-18.823,P<0.05)。7例随访患者中,碘基物质图碘含量治疗前〔(3.71±4.59)100μg/L〕与治疗后〔(10.50±5.57)100μg/L〕明显不同,两者之间差异有统计学意义(t=-6.243,P<0.05)。结论 CT能谱成像可以获得全肺的解剖和功能信息,为肺栓塞提供定性、定量分析,在肺栓塞的诊断和随访中有较高的临床应用价值。更多还原

【Abstract】 Objective To explore the diagnostic value of Gemstone Spectral imaging with HDCT in the diagnosis of pulmonary embolism.Methods 124 patients(64 men,60 women,mean age 63.08±14.23)with suspected PE underwent pulmonary CTA with spectral imaging mode using a GE Discovery CT750HD scanner.Image data sets were reconstructed on a dedicated workstation(Advantage Windows 4.4,GE).CT angiographic images and iodine-based material decompositiaon images were reviewed to evaluate the number and localization of pulmonary embolism,as well as perfusion defects.There were 7 patients underwent pulmonary CTA again after anticoagulation treatment.Two independent samples T-test were used to compare iodine densities between different groups.Results A total of 345 clots with main(n=26,7.54%),lobar(n=70,20.29%),segmental(n=171,49.57%)and sub-segmental(n=78,22.61%)distribution were detected in 34 patients.And there were 133 perfusion defects.There was a significant difference in iodine content between normal lung parenchyma〔(23.86±8.99)100μg/L〕and perfusion defects〔(4.86±4.62)100μg/L〕(t=-18.823,P <0.05).There was a significant difference in the iodine content of perfusion defects before〔(3.71±4.59)100μg/L〕and after anticoagulation〔(10.50±5.57)100μg/L〕(t=-6.243,P <0.05).Conclusion Iodine mapping of CT spectral imaging is a reliable method in the evaluation of pulmonary embolism both qualitatively and quantitatively.更多还原