Johnson P T, Wechsler R J, Salazar A M, Fisher A M, Nazarian L N, Steiner R M
Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
J Comput Assist Tomogr. 1999 May-Jun;23(3):369-73. doi: 10.1097/00004728-199905000-00009.
The goal of this work was to identify and categorize the spectrum of pulmonary parenchymal and pleural abnormalities identified by CT in patients with acute pulmonary thromboembolism (PE).
A review of interpretations from 4,715 consecutive contrast-enhanced thoracic CT studies identified 41 examinations in which the diagnosis of PE was reported. Thirty-four studies were available for review, and two radiologists confirmed intraluminal defects in 31 patients. The number of emboli were counted and localized using bronchopulmonary nomenclature. Associated parenchymal and pleural abnormalities were tabulated.
Of the 31 patients, 13 underwent confirmatory or correlative studies including angiography, radionuclide study, or autopsy. In addition, deep venous thrombosis was confirmed by ultrasound or MRI in 13 patients. An average of 7.5 emboli per patient was detected. Pleuroparenchymal findings were as follows: Nine patients (29%) had no acute pulmonary parenchymal or pleural abnormality. In the remaining 22 patients, pleural effusion was the most common abnormality, found in 14 of 31 (45%). Ten patients (32%) had peripheral wedge-shaped parenchymal opacities suggestive of pulmonary infarction. Normally enhancing lobar atelectasis was seen in nine patients (29%). Six patients (19%) demonstrated heterogeneous parenchymal enhancement within nonaerated lung, two of whom had pathologically proven pulmonary infarct. Thirteen of 31 patients underwent high resolution CT; a typical mosaic perfusion pattern was seen in only 1 patient.
Twenty-nine percent of patients with acute PE had no acute lung parenchymal abnormality on CT; thus, the absence of parenchymal abnormality on CT does not exclude PE. High resolution CT mosaic perfusion was not a common feature of acute pulmonary embolism. Regions of decreased enhancement within nonaerated lung, seen in 19%, may prove to be an indicator of pulmonary infarction; however, this is a nonspecific finding.
本研究旨在识别和分类急性肺血栓栓塞症（PE）患者CT检查发现的肺实质和胸膜异常谱。
回顾连续4715例胸部增强CT检查结果，发现41例报告有PE诊断。可供复查的有34例研究，两名放射科医生在31例患者中确认有管腔内充盈缺损。使用支气管肺命名法对栓子数量进行计数并定位。将相关的实质和胸膜异常情况制成表格。
31例患者中，13例接受了包括血管造影、放射性核素检查或尸检在内的确诊或相关检查。此外，13例患者经超声或MRI确诊有深静脉血栓形成。平均每位患者检测到7.5个栓子。胸膜实质表现如下：9例患者（29%）无急性肺实质或胸膜异常。其余22例患者中，胸腔积液是最常见的异常，31例中有14例（45%）出现。10例患者（32%）有提示肺梗死的外周楔形实质混浊。9例患者（29%）可见正常强化的肺叶肺不张。6例患者（19%）表现为非充气肺内实质强化不均匀，其中2例经病理证实有肺梗死。31例患者中有13例接受了高分辨率CT检查；仅1例患者可见典型的马赛克灌注模式。
29%的急性PE患者CT检查无急性肺实质异常；因此，CT上无实质异常不能排除PE。高分辨率CT马赛克灌注不是急性肺栓塞的常见特征。19%的患者非充气肺内强化减低区域可能是肺梗死的一个指标；然而，这是一个非特异性表现。
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