| 能谱CT在急性肺栓塞诊断及肺血流灌注变化评估中的应用 |
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| 引用本文： | 姚标,李晓峰,刘彩云,石岩.能谱CT在急性肺栓塞诊断及肺血流灌注变化评估中的应用[J].CT理论与应用研究,2019,28(6):693-699. |
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| 作者姓名： | 姚标 李晓峰 刘彩云 石岩 |
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| 作者单位： | 江苏大学附属徐州医院放射科,江苏徐州221005;徐州市肿瘤医院放射科,江苏徐州221005;江苏大学附属徐州医院放射科,江苏徐州221005;徐州市肿瘤医院放射科,江苏徐州221005;江苏大学附属徐州医院放射科,江苏徐州221005;徐州市肿瘤医院放射科,江苏徐州221005;江苏大学附属徐州医院放射科,江苏徐州221005;徐州市肿瘤医院放射科,江苏徐州221005 |
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| 基金项目： | 江苏大学医学临床科技发展基金（JLY20160071；JLY20180119）；徐州市重点研发计划（农业与社会发展）（KC18200）。 |
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| 摘 要： | 目的:探讨能谱CT对急性肺栓塞诊断及肺血流灌注变化评估的应用价值。方法:回顾性分析2017年11月至2019年7月43例怀疑急性肺栓塞的影像资料，所有疑似急性肺栓塞患者行能谱增强扫描，原始数据图像在工作站重建肺动脉血管图像及碘基物质图。观察并记录肺动脉栓子的位置、数目；分析碘基物质图中肺内血流灌注降低区的位置及数目，并测量肺内血流灌注降低区的碘基值及CT值，同时测量同层面或邻近层面正常肺实质的碘基值及CT值。混合能量图像与最佳单能量图像对栓子检出的数量比较采用卡方检验，血流灌注减低区与正常区域碘基值、CT值比较采用两样本秩和检验。结果:明确诊断肺动脉栓塞12例，采用混合能量图像观察发现栓子256个，其中中心型栓子（肺动脉主干、肺叶栓子）22个，外周型（肺段、肺亚段栓子）234个；完全闭塞型栓子58个，非完全闭塞型栓子198个。采用最佳单能量图像观察发现栓子273个，其中中心型栓子（肺动脉主干、肺叶栓子）22个，外周型（肺段、肺亚段栓子）251个；完全闭塞型栓子74个，非完全闭塞型栓子199个。最佳单能量图像在诊断外周型及完全闭塞型栓子较混合能量图像能增加检出数量，但两组比较差异无统计学意义（P>0.05）。肺内血流灌注减低区42处，血流灌注减低区（（2.70±1.81）100μg/mm3、（-829±45.94）HU）与正常区域肺野（（17.78±3.29）100μg/mm3、（-741±34.34）HU）碘基值、CT值比较，差异有统计学意（P<0.05）。结论:能谱CT对肺栓塞能进行定性和定位诊断，碘基物质图能够评价肺血流灌注变化，为评估肺栓塞病情提供信息。
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| 关 键 词： | 急性肺栓塞 肺动脉血管成像 能谱CT |
| 收稿时间： | 2019-07-19 |
Application of Energy Spectral CT in the Diagnosis of Acute Pulmonary Embolism and Evaluation of Pulmonary Perfusion Changes |
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| Institution: | 1. Department of Radiology, Xuzhou Hospital Attached of Jiangsu University, Xuzhou 221005, China;2. Department of Radiology, Xuzhou Cancer Hospital, Xuzhou 221005, China |
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| Abstract: | Objective: To investigate the value of energy spectral CT in the diagnosis of acute pulmonary embolism and pulmonary perfusion changes. Methods: A retrospective analysis of 43 cases of suspected acute pulmonary embolism from November 2017 to July 2019, all patients with suspected acute pulmonary embolism underwent enhanced spectrum scanning, and the original data images reconstructed pulmonary angiography images and iodine-based substances at the workstation. Observe and record the location and number of pulmonary emboli; analyze the location and number of intrapulmonary perfusion reduction zone in the iodine-based substance map, and measure the iodine value and CT value of the intra-poor hypoperfusion zone, and measure the normal lung of the same level or adjacent level Substantial iodine value and CT value. The chi-square test was used to compare the number of emboli detected by the mixed energy image with the best single-energy image. The two-sample rank sum test was used to compare the iodine value and CT value between the perfusion reduction zone and the normal zone. RESULTS: A total of 12 patients with pulmonary embolism were diagnosed. A total of 256 emboli were found by mixed energy imaging. Among them, 22 were central emboli (pulmonary trunk and lobes), and peripheral type (pulmonary and lung sub-emboli) 234. There were 58 fully occluded emboli and 198 non-completely occluded emboli. A total of 273 emboli were found by the best single-energy image observation, including 22 central emboli (pulmonary trunk and lobes) and 251 peripheral (pulmonary and pulmonary emboli); fully occluded embolus 74, 199 non-completely occluded emboli. The best single-energy image had a higher detection rate than the mixed energy image in the diagnosis of peripheral and fully occluded emboli, but the difference was not statistically significant (P>0.05). The intrapulmonary perfusion reduction area was 42, the perfusion reduction area ((2.70±1.81) 100ug/mm3, (-829±45.94) HU) and the normal area lung field ((17.78±3.29) 100ug/mm3, (-741±34.34) HU) iodine value, CT value for comparison, the difference was statistically significant (P<0.05). Conclusion: Energy spectral CT can be used for qualitative and local diagnosis of pulmonary embolism. Iodine-based substance map can evaluate pulmonary blood perfusion changes and provide information for evaluating pulmonary embolism. |
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