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目的评价 X 线胸片、超声心动图、核素肺灌注扫描、电子束 CT(EBCT)、MR 肺动脉造影(MRPA)、肺动脉造影(PAG)在肺动脉栓塞(PTE)诊断中的应用价值。方法自2003年7月至2004年3月间临床确诊的 PTE 患者25例。常规行胸部正侧位摄片、超声心动图、EBCT 肺动脉造影、核素肺灌注扫描、MRPA 及 PAG。PAG 由2名有经验医师共同分析每一支肺动脉及其叶段分支,诊断意见作为标准并与其他方法进行对照。结果 PAG 技术成功率100%,775个受检肺动脉分支中共检出556个分支受累(71.7%)。25例患者中 X 线胸片提示诊断12例。超声心动图诊断9例,右房室增大21例,肺动脉高压18例。核素肺灌注显像结果显示500个肺段中有247个肺段受累(52.0%),与PAG 对照对段的敏感度为64.66%。EBCT 肺动脉造影(EBCTPA)的分析显示775个肺肺动脉分支中共有523个主干及叶段分支受累,段以上分支敏感度为94.06%;10例行 MRPA 的患者中8例检查成功,248各肺动脉分类中共155个分支受累(62.5%),段以上敏感度为81.29%。结论 EBCT 对 PTE的诊断具有较高的敏感度,X 线胸片和超声心动图为必不可少的检查手段,EBCT 可作为一线影像学诊断方法,核素肺灌注扫描及 MRPA 可作为二线诊断方法。
Objective To evaluate the value of X-ray, echocardiography, radionuclide perfusion scanning, electron beam computed tomography (EBCT), MR pulmonary angiography (MRPA) and pulmonary angiography (PAG) in the diagnosis of pulmonary embolism (PTE). Methods Twenty-five patients with PTE were diagnosed from July 2003 to March 2004. Routine lateral chest radiography, echocardiography, EBCT pulmonary angiography, radionuclide lung perfusion scan, MRPA and PAG. The PAG was analyzed by two experienced physicians for each branch of the pulmonary artery and its leaf segments. The diagnostic criteria was used as a standard and compared with other methods. Results The success rate of PAG was 100%. A total of 556 branches were detected in 775 pulmonary artery branches (71.7%). Twenty-five patients were diagnosed by X-ray in 12 cases. Echocardiography in 9 cases diagnosed, right atrial enlargement in 21 cases, pulmonary hypertension in 18 cases. Nuclide lung perfusion imaging showed that 247 pulmonary segments were involved (52.0%) in 500 segments and 64.66% were sensitive to segment PAGs. EBCT pulmonary angiography (EBCTPA) analysis showed that there were 523 branches and leaf segments in 775 branches of pulmonary artery, and the branch sensitivity was 94.06%; 8 of 10 MRPA patients were successfully examined, 248 pulmonary artery classification 155 branches of the CCP (62.5%) were involved, with a sensitivity of 81.29% over the segment. Conclusion EBCT has high sensitivity for the diagnosis of PTE. X-ray and echocardiography are indispensable examination methods. EBCT can be used as a first-line imaging diagnostic method, radionuclide perfusion scan and MRPA can be used as second-line diagnostic method .