螺旋CT肺动脉与下肢静脉联合成像对静脉血栓栓塞症的诊断价值

目的评价螺旋CT肺动脉与下肢深静脉联合成像技术（CTVPA）对静脉血栓栓塞症（VTE）的诊断价值。方法对临床拟诊为肺栓塞（PE）的46例患者行CTVPA成像，先行肺动脉CT成像，后行下肢深静脉扫描，深静脉CT扫描范围从胭静脉至双肾静脉水平。结果46例患者中，CTVPA显示PE患者37例，下肢深静脉血栓（DVT）34例，两者同时存在者30例。37例PE均为多发肺动脉栓子，共累及动脉189支，其中，左右肺动脉主干栓子2．6％（5／189）支，叶动脉30．2％（57／189）支，段动脉50．2％（95／189）支。亚段及亚亚段肺动脉16．9％（32／189）支。34例DVT患者中，左侧20例，右侧12例，盆腔内静脉血栓2例。CTVPA成像检出率较CTPA高10．8％（4/37）。结论16层螺旋CT CTVPA可实现“一站式”检查，对评价肺动脉与下肢深静脉血栓栓塞性疾病有较高的敏感性与特异性。

Diagnosis of venous thromboembolism with 16-slice spiral CT combined pulmonary angiography and deep-venography of lower limb

Objective To evaluate the usefulness of combined CT pulmonary angiography and deep-venography （CTVPA）of the lower limb in the diagnosis of venous thromboembolism （VTE）.Methods Forty-six patients with clinically suspected pulmonary embolism （PE） underwent CTVPA by16-sliee spiral CT.The imaning findings in all patients were retrospectively assessed.Results 37 of 46 patients were identified as PE,34 of 46 patients were found to be deep-venous thromboembolism （DVT）of lower limb,which were co-exist/ng in 30 cases.Thus the addition of CTVPA resulted in a 10.8%（4/37）incremental rate in VTE detection compared with that at CTPA alone. Among 37 patients with PE,the emboli were detected in 189 arteries which comprised 5 left and right pubmonary arteries,57 lobar artefies,95segmental arteries,32 subsegmental and sub-subsegmental arteries.Among 34 patients with DVT, DVTs were detected in 20 left femoropepliteal veius,12 right femoropepliteal veins and 2 pelvic veins,respectively.Conclusion CTVPA by 16-slice spiral CT is characterized by high sensitivity and specificity,thus it can quickly,directly and simultaneously detect the thromboembolism in pulmonary arteries and deepveins of lower limb.