目的: 探讨能谱CT碘定量参数及虚拟肺灌注成像在急性肺动脉栓塞(acute pulmonary embolism, APE)诊断中的应用价值。方法: 回顾性收集因疑似APE接受GE能谱CT肺动脉造影检查的患者。获取70 keV CT肺动脉造影(computed tomography pulmonary angiography, CTPA)单能量图像、碘基物质图及虚拟肺灌注图,记录肺动脉栓子数量、性质及其分级分布,测量栓塞肺组织、对侧健康肺组织及同层面胸主动脉的碘浓度(iodine concentration, IC)及 CT 值,计算标化碘浓度(normalized iodine concentration, NIC)。结果: 最终纳入65例APE患者共402处栓塞,CTPA、CTPA+碘基物质图及CTPA+碘基物质图+能谱虚拟肺灌注图对栓塞的诊断效能依次提升,对3、4级栓子的检出率显著优于单一CTPA(P＜0.05)。定量分析结果显示,与健康肺组织相比,栓塞肺组织在70 keV CTPA单能量图像上的CT值、IC及NIC均显著降低,差异具有统计学意义(P＜0.05)。结论: 能谱CT碘定量参数联合虚拟肺灌注成像可显著提升APE诊断准确性,尤其在肺段、亚段及以下肺动脉栓塞中具有重要价值。
Objective: To explore the application value of spectral CT iodine quantitative parameters and virtual lung perfusion imaging in the diagnosis of acute pulmonary embolism (APE). Methods: The clinical data of patients with suspected APE who underwent GE spectral CT pulmonary angiography were retrospectively collected. Monoenergetic images, iodine-based material decomposition images and virtual lung perfusion images of 70 keV CT pulmonary angiography (CTPA) were obtained. The number, nature and grading distribution of pulmonary embolism were recorded. The iodine concentration (IC) and CT value of embolic lung tissue, contralateral healthy lung tissue and thoracic aorta at the same level were measured, meanwhile the normalized iodine concentration (NIC) was calculated. Results: A total of 402 emboli in 65 patients with APE were finally included. The diagnostic efficacy of CTPA, CTPA+iodine-based material decomposition images and CTPA+iodine-based material decomposition images +specral virtual virtual lung perfusion images for emboli improved successively, and the detection rates of grade 3 and 4 emboli were significantly better than those of single CTPA (P＜0.05). The results of quantitative analysis showed that compared with the healthy lung tissue, the CT value, IC and NIC of the embolized lung tissue on the 70 keV single-energy image of CTPA were significantly reduced, and the differences were highly statistically significant (P＜0.05). Conclusion: Spectral CT iodine quantitative parameters combined with virtual perfusion imaging can significantly improve the diagnostic accuracy of acute pulmonary embolism, especially in the diagnosis of pulmonary embolism in pulmonary segments, sub-segments and below.
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