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目的探讨64层螺旋CT在急性胸痛病因鉴别诊断中的临床价值。方法对36例临床急性胸痛的患者行64层螺旋CT心胸联合血管造影检查。对所有扫描原始数据用冠状、矢状面多平面重组(MPR)、曲面重组(CPR)、容积再现(VR)和最大密度投影(MTP)等方法行冠状动脉、肺动脉和胸主动脉成像。由2名有经验的放射科医生对所有图像进行观察,对疾病进行诊断,其中16例患者同时行选择性血管造影检查。结果所有行64层螺旋CT心胸联合血管造影的患者1次检查均可清晰显示双侧肺动脉、冠状动脉主干及其主要分支以及胸主动脉,同时均可进行纵隔及肺窗重组,对胸部疾病进行诊断。显示冠状动脉狭窄10例,急性肺动脉栓塞14例,主动脉夹层6例(其中1例同时伴有冠状动脉右支急性血栓形成)；并诊断气胸1例、缩窄性心包炎1例；4例未见明显异常。结论64层螺旋CT 1次心胸联合血管造影检查能清晰地显示冠状动脉、肺动脉及主动脉,对其病变作出正确诊断,还能清晰地显示胸部疾病,是急性胸痛病因诊断无创、可靠的检查方法。
Objective To investigate the clinical value of 64-slice spiral CT in the differential diagnosis of acute chest pain. Methods Thirty-six patients with acute chest pain were examined by 64-slice spiral CT combined with angiography. Coronary, pulmonary and thoracic aortas were imaged using all coronal, sagittal planar reconstruction (MPR), surface reconstruction (CPR), volume rendering (VR) and maximum density projection (MTP) for all scanned raw data. All the images were observed by two experienced radiologists to diagnose the disease. Among them, 16 patients underwent selective angiography at the same time. Results All patients undergoing 64-slice CT combined with thoracic and cardiothoracic angiography were able to clearly show the bilateral pulmonary arteries, the main coronary artery and its major branches and the thoracic aorta, and both the mediastinum and lung window were reconstructed. The thoracic diseases diagnosis. Coronary artery stenosis in 10 cases, 14 cases of acute pulmonary embolism, aortic dissection in 6 cases (1 case accompanied by acute right coronary artery thrombosis); and diagnosed pneumothorax in 1 case, constrictive pericarditis in 1 case; 4 cases No obvious abnormalities. Conclusion One-stage 64-slice spiral CT combined angiography can clearly show the coronary arteries, pulmonary arteries and aorta, make correct diagnosis of the lesions, and can clearly show the chest disease. It is a non-invasive and reliable method for the diagnosis of acute chest pain .