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目的应用能谱CT分析亚段栓子位置及栓塞程度对肺灌注减低发生率及程度影响。方法 26例可疑肺动脉栓塞患者行能谱CT肺动脉CTA检查,选取无段及段以上动脉栓塞病例,观察肺动脉内有无栓子,根据栓塞程度分为轻度(<50%)、重度(≥50%)、闭塞3组,观察是否存在灌注减低,并测量灌注减低区及相邻或对侧肺正常区碘含量。结果符合条件肺栓塞患者14例中,共有亚段栓子116个,其中5级78个,6级26个,7级及以下12个。上述3组存在重度以上栓塞的构成比分别为71.8%、73.1%、100%,7级及以下组较第5、6级组构成比高(P<0.01),3组存在碘灌注减低的构成比分别为37.2%、38.5%、83.3%,第7级及以下组较第5、6级高(P=0.01)。在栓塞程度与灌注减低关系上,29个栓子狭窄程度<50%,64个≥50%,23个栓子为闭塞,相应区域碘灌注减低构成比分别为0、40.7%、100%,两两比较差异均有统计学意义(P<0.01);正常肺实质区与栓塞区碘含量差异有显著性(P=0.000);栓塞≥50%组与闭塞组灌注减低程度差异无显著性(P=0.43)。结论在亚段栓塞中,肺灌注减低发生率及减低程度与栓子位置及其栓塞程度密切相关,第7级及以下肺动脉发生重度以上栓塞比例较高,更易导致灌注减低。
Objective To analyze the impact of sub-segment embolism and embolism on the incidence and extent of lung perfusion by using energy spectrum computed tomography (CT). Methods Twenty - six patients with suspicious pulmonary embolism were examined by spectral CT pulmonary angiography (CTA). The patients with or without arterial embolism were selected to observe the presence or absence of emboli in the pulmonary artery. According to the extent of embolism, they were divided into mild (<50%), severe %). The three groups were occluded to observe whether there was perfusion reduction and the iodine content in the normal zone of perfusion-reduced area and the adjacent or contralateral lung were measured. Results Among the 14 patients who met the criteria of pulmonary embolism, there were 116 sub-segments of emboli, of which 5 were 78, 6 were 26, 7 and below 12. The proportions of severe thromboembolism in the three groups were 71.8%, 73.1%, 100% respectively. The ratios of the constituent ratios of grade 7 and group were higher than that of the grade 5 and 6 (P <0.01) (37.2%, 38.5% and 83.3% respectively), while those in the seventh grade and the following groups were higher than the fifth and sixth grades (P = 0.01). In the relationship between embolization and perfusion reduction, 29 emboli were less than 50%, 64 were more than 50%, and 23 emboli were occluded. The I / R ratio in the corresponding area was 0, 40.7% and 100%, respectively There was a significant difference between two groups (P <0.01). There was a significant difference in iodine content between the parenchyma area and the embolic area (P = 0.000). There was no significant difference between the embolization group and the occlusion group = 0.43). Conclusions In the sub-embolization, the incidence and extent of pulmonary perfusion decrease are closely related to the location of the embolus and the degree of embolization. There is a high proportion of embolism in the pulmonary artery of grade 7 and below, which may lead to the decrease of perfusion.