摘要:
目的:探讨CT双能量肺灌注成像(DEPI)与CT肺动脉成像(CTPA)在诊断急性肺栓塞敏感性和特异性上的差异以及CTPA联合DEPI诊断急性肺栓塞的价值。方法:在22只新西兰兔中,实验组20只经耳缘静脉入路注射明胶海绵制成急性肺栓塞模型;对照组2只经耳缘静脉注入生理盐水。栓塞后2小时行CTPA检查及双源CT双能量肺灌注扫描。扫描完毕,处死新西兰兔,行大体解剖及镜下切片观察。以病理为金标准,观察CTPA联合DEPI诊断急性肺栓塞的准确性。结果:对照组CTPA显示肺动脉血管通畅,未见充盈缺损,DEPI图像表现为大致均匀的黄红色伪彩;实验组栓塞后CTPA可见新西兰兔部分段、亚段肺动脉对应肺组织呈磨玻璃、肺纹理稀疏及马赛克改变,栓塞区域灌注图像显示为蓝色或黑色的灌注缺损或者不均匀灌注。病理检查发现亚段以下细小肺动脉栓子,CTPA未发现血管充盈缺损,而DEPI表现为与周围正常灌注区域颜色稍不均匀,呈伪彩图像表现。CTPA及DEPI诊断肺栓塞的敏感度、特异度、阳性预测值、阴性预测值分别为97.22%,98.65%,97.22%,98.65%;97.37%,95.83%,92.50%,98.57%。结论:DEPI对于急性肺栓塞的检出率具有较高敏感度;CTPA联合DEPI可提高急性肺栓塞的诊断率。
Abstract:
Objective: Study the diagnosis value of CTPA combined with dual energy CT lung perfusion imaging(DEPI) in acute pulmonary embolism, and the sensitivity of the DEPI to diagnosis the acute pulmonary embolism. Methods: The experimental group with 20 New Zealand rabbits. Acute pulmonary embolism models of rabbits were established by injection of gelatin sponge through the ear vein. The control group 2 New Zealand rabbits injected saline via the same path. The CTPA scan and dual energy CT lung perfusion imaging were collected successively after 2 hours then kill all rabbits. Observe the rabbit lung tissue with the gross anatomy and microscope. With the pathology as the gold standard to evaluate the accuracy of CTPA combined with DEPI in the diagnosis of acute pulmonary embolism. Results: In the control group, the CTPA show pulmonary artery patency, no filling defect, DEPI images show a substantially uniform yellow and red color. Experimental group after embolization of CTPA show visible ground-glass attenuation, lung tissue lung texture sparse and Mosaic change in part of pulmonary artery corresponding lung tissue in New Zealand rabbits, and embolism regional perfusion images displayed in blue or black perfusion defects or uneven perfusion. Pathological examination revealed small pulmonary embolus occurs, CTPA found no vascular filling defect, and DEPI show is slightly uneven image with normal perfusion regional color. The sensitivity, specificity, positive predictive value and negative predictive value of CTPA and DEPI in the diagnosis of pulmonary embolism were 97.22%, 98.65%, 97.22%98.65%; 97.37%, 95.83%, 92.50%, 98.57%. Conclusion: DEPI with a high sensitivity for the detection of acute pulmonary embolism; CTPA combined with DEPI can improve the diagnostic rate of acute pulmonary embolism.
百度学术
下载:
