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目的探讨多层螺旋CT三期动态增强扫描方法诊断肺栓塞的可行性及其对肺栓塞病理及病理生理学改变的诊断意义方法分析20例临床疑诊肺栓塞患者CT平扫及多期动态增强扫描表现。增强扫描使用非离子型水溶性碘剂,浓度300mgI/L,量100ml,3ml/s高压注射。其中两期增强扫描9例,延迟时间分别为20~25s和60s;三期增强扫描11例,延迟时间分别5~15s、25~32s和60~80s。结果三期增强扫描中,Ⅰ期(肺动脉期)延迟5~7s,可从密度上区别肺动、静脉及左右心腔;Ⅱ(主动脉期)延迟23~25s,胸内各血管均达到最佳强化,肺动脉栓子此期显示最清晰;Ⅲ期(实质期)延迟60s,实质组织及肺门气管周围淋巴结有强化。结论三期增强扫描中主动脉期是主要期程,是诊断肺栓塞显示肺动脉内栓子的最好时相,肺动脉期实质期可以起到辅助诊断肺栓塞的继发性病理及病理生理改变及鉴别诊断作用。
Objective To investigate the feasibility of multi-slice spiral CT three-phase dynamic contrast-enhanced scanning in the diagnosis of pulmonary embolism and its significance in the pathological and pathophysiological changes of pulmonary embolism. Methods To analyze CT scan and multi-phase dynamic contrast-enhanced scanning in 20 cases of suspected clinical pulmonary embolism which performed. Enhanced scanning using non-ionic water-soluble iodine, concentration 300mgI / L, the amount of 100ml, 3ml / s high pressure injection. Among them, 9 cases were enhanced by two phases, and the delay time was 20 ~ 25s and 60s respectively. Eleven patients underwent enhanced three-phase scan with delay time of 5 ~ 15s, 25 ~ 32s and 60 ~ 80s respectively. Results In phase Ⅲ enhanced scan, stage Ⅰ (pulmonary artery phase) was delayed by 5 ~ 7s, which could differentiate pulmonary artery, vein and left and right cardiac cavity from density. Ⅱ (aortic phase) delayed 23 ~ 25s, Good enhancement, pulmonary embolism showed the most clear in this period; Ⅲ period (puberty) delayed 60s, parenchymal tissue and pulmonary hilar trachea around the lymph nodes have enhanced. Conclusions The aortic phase is the main course in the third phase of enhanced scan. It is the best time to diagnose pulmonary embolism in pulmonary embolism. The pulmonary arterial phase can play an important role in secondary diagnosis of pulmonary embolism and pathophysiological changes. Differential diagnosis.