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目的探讨多排螺旋CT在肺栓塞诊断中的应用价值。方法对临床怀疑肺动脉栓塞经多排螺旋CT肺动脉造影(MSCTPA)及临床确诊的15例患者临床资料进行回顾性分析。结果15例肺栓塞患者中,14例诊断为肺栓塞,诊断率约93.3%。1035支肺动脉显示849支,显示率82%;肺栓塞130支,占显示肺动脉数的15.3%。其中亚段肺动脉600支中显示438支,显示率73%,栓塞43支占显示亚段肺动脉的9.8%。直接征象包括不同程度的充盈缺损及动脉断面变细,血管腔内密度不均匀减低。充盈缺损分为4种形式:中央性充盈缺损3例呈轨道征,偏侧性充盈缺损9例,附壁性充盈缺损2例,完全性阻塞3例。间接征象包括马赛克征1例,胸膜下楔形梗死灶3例,肺动脉高压5例,出现W esterm ark征8例,胸腔积液6例。结论MSCTPA是诊断肺栓塞快速、安全有效、无创的诊断方法,它将取代肺动脉造影成为肺栓塞诊断的首选手段。
Objective To investigate the value of multislice spiral CT in the diagnosis of pulmonary embolism. Methods The clinical data of 15 patients with clinically suspected pulmonary embolism by multi-slice spiral CT pulmonary angiography (MSCTPA) and clinically diagnosed were retrospectively analyzed. Results Of the 15 cases of pulmonary embolism, 14 cases were diagnosed as pulmonary embolism with a diagnosis rate of 93.3%. 1035 pulmonary arteries showed 849, the rate was 82%; 130 pulmonary embolism, accounting for 15.3% of the number of pulmonary arteries. Among them, there were 438 pulmonary arteries in the sub-segment, showing a rate of 73%, and embolization of 43 arteries showed 9.8% of the pulmonary arteries in the sub-segment. Direct signs include varying degrees of filling defect and arterial section thinning, uneven lumen density decreased. Filling defects were divided into four forms: central filling defect in 3 cases showed orbital signs, partial filling defects in 9 cases, 2 cases of apical filling defect, complete obstruction in 3 cases. Indirect signs include 1 case of mosaic syndrome, 3 cases of subpleural wedge-shaped infarction and 5 cases of pulmonary hypertension. There were 8 cases of Westerm ark sign and 6 cases of pleural effusion. Conclusion MSCTPA is a rapid, safe, effective and noninvasive diagnostic method for pulmonary embolism. It will replace pulmonary angiography as the first choice of pulmonary embolism diagnosis.