肺栓塞肺动脉能谱CT胸部扫描影像学特征及其诊断价值

目的：探讨肺栓塞（PE）肺动脉能谱CT胸部扫描影像学特征及其诊断价值。方法：回顾性分析53例高度疑似PE患者，获取单能量能谱CT肺动脉造影（CTPA）图像和碘基肺灌注图，记录CTPA图像和碘基肺灌注图检出的肺动脉栓子数目及其分布、分型情况；分析肺动脉能谱CT胸部扫描影像学特征；比较不同栓塞程度及类型能谱CT扫描碘基值；比较栓塞区与对照区能谱CT扫描碘基值、水基值和CT值等能谱CT扫描参数。结果：以CTPA为金标准，53例高度疑似PE的患者中确诊32例。能谱CTPA检出162个栓子，完全型栓子37个，非完全型栓子125个；碘基肺灌注图检出171个栓子，完全型栓子49个，非完全型栓子122个。中心型、偏心型和完全型栓子栓塞区能谱CT扫描碘基值均明显低于对照区（P<0.05）；附壁型栓子栓塞区能谱CT扫描碘基值与对照组无显著差异（P>0.05）；完全型栓塞区碘基值显著低于中心型、偏心型和附壁型等非完全型栓塞区（P<0.05）。结论：PE肺动脉能谱CT胸部扫描影像学特征主要表现为肺动脉内充盈缺损、肺动脉扩张、肺动脉高压、马赛克征、轨道征等征象，肺动脉能谱CT胸部扫描碘基肺灌注...

Imaging characteristics and diagnostic value of energy spectral CT pulmonary angiography for pulmonary embolism

Objective To explore the imaging characteristics of energy spectral CT pulmonary angiography (CTPA) for pulmonary embolism (PE) and explore its diagnostic value. Methods A total of 53 cases of highly suspected PE were retrospectively analyzed. The single-energy spectral CTPA images and iodine-based material decomposition images for lung perfusion detection were obtained to record the number, distribution and classification of pulmonary emboli. The imaging characteristics of CTPA were analyzed. The iodine concentrations in spectral CT for patients with different degrees and types of embolism were compared, and the spectral CT scan parameters (iodine concentration, water concentration and CT number) in embolism area and control area were compared. Results Taking CTPA as the golden standard, in the 53 patients with highly suspected PE, there were 32 confirmed cases. Energy spectral CTPA showed that there were 162 emboli, including 37 complete emboli and 125 incomplete emboli, while the iodine-based material decomposition image showed that there were 171 emboli, including 49 complete emboli and 122 incomplete emboli. For central, eccentric and complete emboli, the iodine concentrations in embolism area were significantly lower than those in control area (P<0.05), but for wall-attached emboli, there was no significant difference between embolism area and control area (P>0.05). In embolism area, the iodine concentration of complete emboli was significantly lower than those of incomplete emboli (central, eccentric and wall-attached) (P<0.05). Conclusion The imaging characteristics of pulmonary artery energy spectrum CT chest scan include filling defect in pulmonary artery, pulmonary artery dilatation, mosaic sign, orbital sign and pulmonary infarction. The images of iodine-based pulmonary perfusion can be applied as the imaging basis for the early diagnosis of PE and the evaluation of embolism severity.