摘要
目的分析慢性血栓栓塞性肺动脉高压(CTEPH)患者CT肺血管造影(CTPA)的特征。方法对2015年12月至2019年12月在中日友好医院完成CTPA并确诊的CTEPH患者的临床资料、CTPA影像学直接和间接征象进行总结,采用描述性研究方法,分析CTEPH患者CTPA影像学特征,并根据血栓起始部位分为近段病变组和远端病变组,比较不同部位病变患者之间的影像学征象是否存在差异。结果共纳入135例CTEPH患者,CTPA显示血栓病变分布上,133例(98.5%)为双肺分布,血栓起始部位分级以Ⅰ、Ⅱ和Ⅲ级为主,Ⅳ级病变仅8例(7.3%),无0级病变。CTEPH患者慢性血栓在CTPA上最常见的直接征象为血管闭塞(134例,99.3%),其次是偏心附壁充盈缺损(111例,88.2%)、蹼样征(80例,59.3%)、血管狭窄/纤细(41例,30.4%)。近段病变与远端病变组患者比较,偏心附壁充盈缺损、血管壁不规则更常见于近端病变者,而血管狭窄/纤细更常见于远端病变组患者(P值均<0.05)。肺实质与胸膜腔继发改变在CTPA上最常见的征象为马赛克征(104例,77.0%),其次是肺梗死灶(79例,58.5%),肺梗死的表现形式包括胸膜下斑片状实变密度影(35/79,44.3%),其次为索条影(23/79,29.1%),斑片状实变密度影与索条影并存(13/79,16.5%)。心脏与大血管异常的最常见CTPA征象为肺动脉增宽(132例,97.8%)和右心室肥大(130例,96.3%),其他包括下腔静脉造影剂逆流(70例,51.9%)、支气管动脉扩张(68例,50.3%)。所有继发征象在近段病变与远端病变组差异均无统计学意义(P值均>0.05)。结论CTEPH患者CTPA最常见直接征象为血管闭塞、附壁充盈缺损及蹼样征,常见间接征象包括肺内马赛克征、肺梗死灶、右心室肥大、肺动脉扩张、体循环动脉扩张等,而附壁充盈缺损更常见于近端病变患者。
Objective To investigate the imaging findings of CT pulmonary angiography(CTPA)in patients with chronic thromboembolic pulmonary hypertension(CTEPH).Methods Consecutive CTEPH cases admitted to receive CTPA in China-Japan Friendship Hospital from December 2015 to December 2019 were enrolled with prospective data collected.The medical histories,imaging manifestation and hemodynamic parameters were analyzed.Patients were divided into proximal lesions group and distal lesions group according to the site of thrombus,and imaging findings were compared between these two groups.Results In 135 cases of CTEPH,CTPA showed thrombus in both lungs in the majority of patients(133 cases,98.5%)with location of thromboembolic disease in levelⅠ,Ⅱand Ⅲ for most patients,only 8 cases with level Ⅳ(7.3%)and no level 0 patients.The most common signs of chronic thrombus were vessel cutoffs(134 cases,99.3%),eccentric wall-adherent filling defects(111 cases,88.2%),web or bands(80 cases,59.3%),stenosis(41 cases,30.4%).Compared to patients with distal lesions,eccentric wall-adherent filling defects,irregular vessel wall were more common in patients with proximal lesions,stenosis was more common in distal lesions,all P<0.05.The most common lung parenchymal signs were mosaic attenuation(104 cases,77.0%),and pulmonary infarction(79 cases,58.5%).Pulmonary infarction included pleura-based consolidation opacity(35/79,44.3%),linear opacities(23/79,29.1%),or both(13/79,16.5%).Pulmonary artery enlargement(132 cases,97.8%)and right ventricular hypertrophy(130 cases,96.3%)were common,other signs included contrast reflux into the inferior vena cava(70 cases,51.9%),enlargement of bronchial arteries(68 cases,50.3%).No differences were found for all the secondary signs between patients with proximal lesions and those with distal lesions,all P>0.05.Conclusions Vessel cutoffs,eccentric wall-adherent filling defects,web or bands are the most common CTPA findings of chronic thrombus in CTEPH.Secondary signs include mosaic attenuation,pulmonary infarction,pulmonary artery enlargement,right ventricular hypertrophy and enlargement of bronchial arteries.Eccentric wall-adherent filling defects are more common in patients with proximal lesions than those with distal lesions.
作者
谢万木
刘敏
杨宏伟
陶新曹
林凡
甄雅南
万钧
翟振国
Xie Wanmu;Liu Min;Yang Hongwei;Tao Xincao;Lin Fan;Zhen Yanan;Wan Jun;Zhai Zhenguo(Department of Pulmonary and Critical Care Medicine,Center of Respiratory Medicine,China-Japan Friendship Hospital/Institute of Respiratory Medicine,Chinese Academy of Medical Sciences/National Clinical Research Center for Respiratory Diseases,Beijing 100029,China;Department of Radiology,China-Japan Friendship Hospital,Beijing 100029,China;Department of Cardiovascular Surgery,China-Japan Friendship Hospital,Beijing 100029,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2020年第26期2012-2017,共6页
National Medical Journal of China
基金
国家重点研发计划(2016YFC0905600)
中国医学科学院医学与健康科技创新工程(2018-I2M-1-001)。
关键词
高血压
肺性
肺栓塞
影像学
CT肺血管造影
回顾性病例分析
Hypertension
pulmonary
Pulmonary embolism
Imaging
CT pulmonary angiography
Restrospective case analysis
