目的 探索能谱CT在低放射剂量下,通过肺碘基图成像技术,检测肺动脉栓塞(pulmonary embolism,PE)患者肺亚段及以下低灌注区的能力.方法 本研究利用CT能谱成像物质分离技术得到32例肺动脉栓塞病人的碘基图,在后处理工作站上计算碘基图上的肺亚段及以下动脉的低密度碘沉积区和对侧正常区的面积和碘含量,以及单能量CT肺动脉造影(CTPA)中对应区域的CT值,然后使用配对Wilcoxon检验比较病变区和正常区之间面积、碘含量及CT值的差异;最后检测低密度碘沉积区与CTPA图中肺亚段以上栓塞栓子的面积,并使用Pearson相关分析栓子面积和碘低密度区面积的关系.结果 分别检测到23例PE患者肺碘基物质图上发现亚段及以下区存在35处碘低密度区,发现肺碘低密度区的碘含量较对侧正常肺组织碘含量明显降低,两者差异有统汁学意义[(0.28±0.13) g/L vs.(2.54 ±0.59) g/L,Z=-6.3,P＜0.01].而在CTPA肺动脉造影图发现,对应碘基图低密度区的CT值比对侧正常区略降低,但差异无统计学意义[碘基图低密度区:(-817.70±93.46)Hu vs.对侧正常区:(-802.81 ±140.11)Hu,Z=-0.43,P＞0.05].结论 能谱CT碘基图技术可为肺栓塞患者的肺亚段下梗死区的准确诊断提供可靠数据,将为临床肺栓塞早期诊断和治疗提供有效手段.

OBJECTIVE To explore the clinical value of spectral CT iodine-based material imaging in diagnosis of the elderly pneumonia patients complicated with pulmonary embolism so as to perform the diagnosis and treatment in early stage .METHODS The elderly pneumonia patients complicated with pulmonary embolism underwent the con-ventional CT scanning and spectral enhanced scanning ,then the iodine contents of perfusion defects ,pneumonia lesions ,and normal lung parenchyma were observed and measured ,and the two groups were compared by using the Chi-square test for categorical data .RESULTS The iodine content in the lung perfusion defects was (0 .32 ± 0 .21)g/L ,the pneumonia lung segment (0 .461 ± 0 .31)g/L ,the contralateral or adjacent normal lung paren-chyma (1 .93 ± 0 .45)g/L ,and there was significant difference in the iodine content between the lung perfusion de-fects and the contralateral or adjacent normal lung parenchyma (Z= -5 .63 ,P<0 .01) ,but there was no significant difference in the iodine content between the lung perfusion defects and the pneumonia lung segment .The accord-ance rate of the iodine-based materials imaging and pulmonary artery CT imaging was 93 .1% in diagnosis of com-plete embolism lesions ,91 .1% in diagnosis of partial embolism lesions .CONCLUSION The spectral CT iodine-based materials imaging provides a new imaging method for the diagnosis of the elderly pneumonia patients compli-cated with pulmonary embolism .

OBJECTIVE To explore the clinical diagnostic value of CT pulmonary angiogram (CTPA ) in septic pulmonary embolism (SPE) induced by right-sided infective endocarditis (RIE) .METHODS Totally 10 suspected patients with SPE induced by RIE during Jun .2012 to Jun .2013 in our hospital were selected and underwent con-ventional CT plain scan and CTPA .After reconstruction along the main pulmonary artery ,five areas (regions of interest ,ROI) on each pulmonary trunk were selected ,the presence of emboli was observed ,and the emboli loca-tion ,number ,degree and iodine content in the pulmonary artery were recorded and analyzed with SPSS 17 .0 . RESULTS The 10 patients were present with a total of 39 emboli ,including 13 emboli in the lung lobe ,20 in the pulmonary segment ,and 6 in the secondary segment .Twenty-five emboli were obliterative and 14 were non-obli-terative .All obliterative embolism showed decreased perfusion ,as well as 3 cases of non-obliterative embolism . For the pulmonary artery containing SPE , there was statistically difference in ROI contents ( P < 0 .01 ) . CONCLUSION CTPA can detect small emboli in the pulmonary artery and pulmonary embolism in concealed parts , which has important implications for SPE induced by RIE .

<正>随着人口老龄化社会的到来,心脏病变在老年中发病率所占比例也越来越高,而冠心病是动脉粥硬化导致脏器损害的最常见类型,是严重危害人类康的常见病[1]。双源CT是一项最新技术,其极高图像时间空间分辨率,使其成为心脏冠状动脉检查好的无创影像方法。目前被认为是可准确评价冠动脉的无创手段[2,3]。其快速、清晰的扫描特点在用于老年冠心病患者的临床检查时,可以明显减少心率、心律不齐或呼吸伪影造成的冠状动脉伪影,