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目的:应用双源CT低剂量对比剂双能量肺灌注成像评估急性肺动脉栓塞患者血管内血栓与肺灌注缺损间的关系,以提高对肺动脉栓塞诊断的准确性。方法:随机选择无肺动脉栓塞患者的低剂量与常规剂量双能量肺灌注成像各15例,对比分析其图像质量;收集20例疑肺动脉栓塞患者行低剂量双能量肺灌注成像;同时获得肺动脉CTA及肺灌注图像。分析肺动脉内有无血栓,以及血栓的部位、数量及形态特征。用双能量肺灌注分析软件判断有无灌注缺损及缺损的部位、形态及范围。对比分析并统计肺动脉内血栓与肺灌注缺损间的关系。结果:肺动脉栓塞患者的低剂量与常规剂量双能量肺灌注成像质量无明显差异(P>0.05)。20例疑似病例中,15例诊断为肺动脉栓塞,其中13例患者肺灌注图像中出现102个肺叶、肺段、或亚段灌注缺损,4例共6个灌注缺损CTA无明确血栓;11例肺动脉CTA显示43个血栓,其中9例血栓与灌注缺损同时存在,2例CTA共5个血栓肺内无灌注缺损。75个灌注缺损与栓塞肺动脉供血范围一致,21个灌注缺损(8段、13亚段)与肺动脉供血范围无关。结论:综合分析双源CT低剂量双能量肺灌注图与CTPA,可以提高肺动脉栓塞诊断的准确性。
OBJECTIVE: To assess the relationship between intravascular thrombosis and pulmonary perfusion defect in patients with acute pulmonary embolism by dual-source CT low-dose contrast agent dual-energy lung perfusion imaging to improve the accuracy of pulmonary embolism diagnosis. Methods: A total of 15 patients with pulmonary embolism without pulmonary embolism were randomly divided into two groups: low-dose and high-dose lung perfusion imaging, 15 cases were compared with each other, and 20 cases with suspected pulmonary embolism were performed low-dose dual-energy lung perfusion imaging. Lung perfusion images. Analysis of pulmonary artery thrombosis, and thrombosis, the number and shape characteristics. Dual-energy lung perfusion analysis software to determine the presence or absence of perfusion defects and defects in the site, shape and scope. The relationship between pulmonary thrombosis and pulmonary perfusion defect was analyzed and compared. Results: There was no significant difference in the quality of pulmonary perfusion imaging between low dose pulmonary artery embolization and conventional dose (P> 0.05). Of the 20 suspected cases, 15 were diagnosed as pulmonary embolism, of which 102 lung, lung segment, or sub-segment perfusion defects were found in 13 lung perfusion images, and 6 of 6 perfusion defects did not have definite thrombus in CTA. Eleven pulmonary arteries CTA showed 43 thrombi, of which 9 thrombosis and perfusion defect co-exist, 2 cases of CTA total 5 thrombus lung perfusion defect. Thirty-seven perfusion defects were consistent with pulmonary embolism, and 21 perfusion defects (segments 8 and 13) had no relationship with pulmonary artery. Conclusion: A comprehensive analysis of low-dose dual-energy CT dual-source CT perfusion and CTPA can improve the diagnostic accuracy of pulmonary embolism.