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目的评价双源双能量CT与3.0 T MR诊断家兔急性肺栓塞的准确性。材料与方法经股静脉注入明胶海绵栓子制作家兔急性肺动脉栓塞模型,栓塞后2 h行双能量CT及MRI,得到CT肺动脉图像(CTPA)、双能量肺灌注图像(DEPI)及MR肺动脉图像(MRPA)和MR肺灌注图像(MRPP)。以肺叶为单位,记录栓塞的数目和部位。以病理学为金标准,计算上述方法诊断肺栓塞的敏感性、特异性和一致性。结果 CTPA、DEPI检测肺动脉栓塞的敏感性分别为95.8%、95.8%;特异性分别为94.1%、90.2%;MRPA和MRPP的敏感性和特异性分别为83.3%、90.2%;37.5%、98%。CTPA与DEPI对急性肺动脉栓塞检测的吻合度非常好(Kappa值=0.971,P<0.001),DECT(CTPA和DEPI联合)与MRPA对急性肺动脉栓塞检测的吻合度较好(Kappa值=0.796,P<0.001)。对于诊断急性肺动脉栓塞DECT与MRPA的差别无统计学意义(P>0.05);但DEPI诊断肺栓塞的准确性(92%)高于MRPP(78.7%),差别有统计学意义(P<0.001)。结论双源CT诊断家兔实验性急性肺动脉栓塞的敏感性略高于MRPA,但差别无统计学意义;DEPI显示肺栓塞所致的灌注缺损优于MRPP。
Objective To evaluate the accuracy of dual-source dual-energy CT and 3.0 T MR in the diagnosis of acute pulmonary embolism in rabbits. MATERIALS AND METHODS A rabbit model of acute pulmonary embolism was established by injection of gelatin sponge emboli via femoral vein. Dual-energy CT and MRI were performed 2 hours after embolization. CT pulmonary artery imaging (CTPA), dual energy perfusion imaging (DEPI) and MR pulmonary artery imaging (MRPA) and MR lung perfusion imaging (MRPP). The lung lobes as a unit, record the number and location of embolus. To pathology as the gold standard, calculate the sensitivity, specificity and consistency of the above method to diagnose pulmonary embolism. Results The sensitivity and specificity of CTPA and DEPI for detecting pulmonary embolism were 95.8% and 95.8%, respectively, with specificity of 94.1% and 90.2% respectively. The sensitivity and specificity of MRPA and MRPP were 83.3%, 90.2%, 37.5% and 98% . The agreement between CTPA and DEPI in acute pulmonary embolism was very good (Kappa = 0.971, P <0.001). The coincidence of DECT (CTPA and DEPI) with MRPA in acute pulmonary embolism was better (Kappa = 0.796, P <0.001). There was no significant difference between DECT and MRPA in the diagnosis of acute pulmonary embolism (P> 0.05). However, the diagnostic accuracy of DEPI for pulmonary embolism was 92% higher than that of MRPP (78.7%) (P <0.001) . Conclusions Dual-source CT is more sensitive than MRPA in the diagnosis of acute pulmonary embolism in rabbits, but the difference is not statistically significant. DEPI shows that perfusion defect caused by pulmonary embolism is better than MRPP.