肺栓塞應(yīng)首選CT血管造影

醫(yī)案日記 2023-06-18 19:01:34

肺栓塞應(yīng)首選CT血管造影

美國(guó)哈佛大學(xué)醫(yī)學(xué)院Wittram等進(jìn)行的一項(xiàng)研究表明,就檢測(cè)肺栓子而言,CT肺血管造影的敏感性顯著高于標(biāo)準(zhǔn)血管造影

。(Radiology2007,244∶883)

該研究是“肺栓塞診斷前瞻性調(diào)查(PIOPED)”的II期研究,共納入226例可疑肺栓塞的患者,分別進(jìn)行CT血管造影和標(biāo)準(zhǔn)血管造影,兩項(xiàng)檢查的平均間隔時(shí)間為40小時(shí)。

結(jié)果顯示,206/266例患者兩項(xiàng)檢查結(jié)果一致,結(jié)果不一致的20例中,男女各半,平均年齡49歲,其中7例CT血管造影陰性,13例陽(yáng)性;標(biāo)準(zhǔn)血管造影結(jié)果則剛好相反;CT血管造影診斷肺栓塞的敏感性為87%,標(biāo)準(zhǔn)血管造影為32%。標(biāo)準(zhǔn)血管造影有1例假陽(yáng)性,13例假陰性;而CT血管造影只有2例假陰性,另外有4例CT血管造影真陰性,而標(biāo)準(zhǔn)血管造影陽(yáng)性

。研究者認(rèn)為,這是由于兩項(xiàng)檢查間期血栓形成或?qū)Ч軝z查的并發(fā)癥

。

研究者認(rèn)為,CT血管造影可以放心地作為肺栓塞的一線檢查,當(dāng)CT血管造影不確定時(shí),應(yīng)行標(biāo)準(zhǔn)血管造影

。

CTPA有幾種掃描方法
？

CT肺血管造影 CT pulmonary angiogram (CTPA) is a medical diagnostic test that employs computed tomography to obtain an image of the pulmonary arteries. Its main use is to diagnose pulmonary embolism (PE).[1] It is a preferred choice of imaging in the diagnosis of PE due to its minimally invasive nature for the patient, whose only requirement for the scan is an intravenous line. Modern MDCT (multi-detector CT) scanners are able to deliver images of sufficient resolution within a short time period, that CTPA has now supplanted previous methods of testing, such as isotope scanning or direct pulmonary angiography, as the gold standard for diagnosis of pulmonary embolism. The patient receives an intravenous injection of an iodine-containing contrast agent at a high-rate using an injector pump. Images are acquired with the maximum intensity of radio-opaque contrast in the pulmonary arteries. This can be done using bolus tracking. A normal CTPA scan will show the contrast filling the pulmonary vessels, appearing as bright white. Any mass filling defects, such as an embolus, will appear dark in place of the contrast, filling/blocking the space where blood should be flowing into the lungs. CT肺血管造影（CTPA）是一醫(yī)療診斷測(cè)試

，采用計(jì)算的斷層掃描

，以獲得圖像的肺動(dòng)脈。它的主要用途是診斷肺栓塞（PE）。 [1]這是一個(gè)首選的影像在診斷PE由于其微創(chuàng)性的病人

，唯一的要求是一種靜脈掃描線

。，現(xiàn)代MDCT（多排螺旋CT）掃描儀能夠提供足夠高的分辨率的圖像

，在很短的時(shí)間內(nèi)

，CTPA現(xiàn)在已經(jīng)取代了以前的測(cè)試方法，如同位素掃描或直接肺血管造影

，診斷為肺金標(biāo)準(zhǔn)等癥

。病人接受靜脈注射含碘造影劑在一個(gè)高速率使用的噴射器泵。畫像獲取在肺動(dòng)脈無(wú)線電不透明對(duì)比度的

，其最大強(qiáng)度

。這是可以做到使用丸劑跟蹤。一個(gè)正常的CTPA掃描將顯示的對(duì)比度

，顯示為亮白色填充肺血管

。任何填充的缺陷，如栓子的質(zhì)量

，會(huì)出現(xiàn)暗代替對(duì)比度

，灌裝/阻斷血液的空間應(yīng)流入肺部。 Diagnostic use診斷使用CTPA was introduced in the 1990s as an alternative to ventilation/perfusion scanning, which relies on radionuclide imaging of the blood vessels of the lung. It is regarded as a highly sensitive and specific test for pulmonary embolism.[1] CTPA is typically only requested if pulmonary embolism is suspected clinically. If the probability of PE is considered low, a blood test called D-dimer may be requested. If this is negative and risk of a PE is considered negligible, then CTPA or other scans are generally not performed. Most patients will have undergone a chest X-ray before CTPA is requested.[1] After initial concern that CTPA would miss smaller emboli, a 2007 study comparing CTPA directly with ventilation/perfusion scanning found that CTPA identified more emboli without decreasing the risk of long-term complications compared to V/Q scanning.[2] CTPA是在20世紀(jì)90年代作為一種替代通氣/灌注掃描

，這依賴于放射性核素肺血管成像的

。它被看作是一個(gè)高度敏感的和具體的測(cè)試肺栓塞[1] 。

，CTPA通常只要求如果臨床上懷疑有肺栓塞時(shí)

。如果PE的概率被認(rèn)為是低，血液測(cè)試

，稱為D-二聚體可能會(huì)被要求

。如果這是陰性和風(fēng)險(xiǎn)的PE被認(rèn)為可以忽略不計(jì)，那么CTPA或其他掃描一般不進(jìn)行

。大多數(shù)患者都經(jīng)歷了一個(gè)胸部透視前CTPA要求

。 [1] 在最初的關(guān)注CTPA會(huì)錯(cuò)過(guò)較小的栓子，2007年的研究比較CTPA直接與通氣/灌注掃描發(fā)現(xiàn)

，CTPA不降低長(zhǎng)期并發(fā)癥的風(fēng)險(xiǎn)相比

，V / Q掃描發(fā)現(xiàn)了更多的栓子。 [2]

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