Bergin C J, Sirlin C, Deutsch R, Fedullo P, Hauschildt J, Huynh T, Auger W, Brown M
Department of Radiology, University of California, San Diego 92103, USA.
AJR Am J Roentgenol. 2000 Feb;174(2):509-15. doi: 10.2214/ajr.174.2.1740509.
We sought to identify imaging features that help predict surgical success in patients undergoing thromboendarterectomy.
Thirty-nine consecutive patients who underwent pulmonary angiography and thromboendarterectomy during 1995 and 1996 were included. Thirty-four underwent helical CT angiography. Measurements of postoperative pulmonary vascular resistance were compared with preoperative imaging features and preoperative pulmonary vascular resistance.
The best imaging indicators of a relatively high postoperative pulmonary vascular resistance were the extent of small vessel disease identified on CT angiograms as segments with abnormal perfusion but normal segmental arteries (p = 0.005) and the extent of central disease (p = 0.015). Combined with preoperative pulmonary vascular resistance, these features had a strong correlation with postoperative outcome (p = 0.0005). Segmental arterial disease seen on both conventional angiography and CT angiography correlated poorly with surgical outcome.
In patients with chronic thromboembolic pulmonary hypertension, CT angiographic evidence of extensive central vessel disease and limited small vessel involvement indicates a favorable surgical outcome.
我们试图确定有助于预测接受血栓内膜剥脱术患者手术成功的影像学特征。
纳入了1995年至1996年间连续39例接受肺血管造影和血栓内膜剥脱术的患者。其中34例接受了螺旋CT血管造影。将术后肺血管阻力的测量结果与术前影像学特征及术前肺血管阻力进行比较。
术后肺血管阻力相对较高的最佳影像学指标是CT血管造影上识别出的小血管病变范围，即灌注异常但节段动脉正常的节段（p = 0.005）以及中央病变范围（p = 0.015）。结合术前肺血管阻力，这些特征与术后结果有很强的相关性（p = 0.0005）。传统血管造影和CT血管造影上均可见的节段性动脉病变与手术结果的相关性较差。
在慢性血栓栓塞性肺动脉高压患者中，CT血管造影显示广泛的中央血管病变且小血管受累有限表明手术结果良好。
