Schoepf U J, Bruening R, Konschitzky H, Becker C R, Knez A, Weber J, Muehling O, Herzog P, Huber A, Haberl R, Reiser M F
Departments of Clinical Radiology, Klinikum Grosshadern, University of Munich, Marchioninistrasse 15, 81377, Germany.
Radiology. 2000 Dec;217(3):693-700. doi: 10.1148/radiology.217.3.r00dc08693.
To comprehensively assess thoracic anatomy and pulmonary microcirculation in pulmonary embolism by using computed tomographic (CT) angiography of the pulmonary arteries combined with functional CT imaging of blood flow.
Twenty-two patients suspected of having acute pulmonary embolism underwent contrast material-enhanced thin-section electron-beam CT angiography of the pulmonary arteries. In addition, in each patient, a dynamic multisection blood flow CT study was performed on a 7.6-cm lung volume with electrocardiographic gating. Pulmonary blood flow was calculated, and perfusion parameters were visualized on color-coded maps. The color-coded maps and CT angiograms were independently evaluated, segment by segment, by two readers for perfusion deficits and the presence of clots, respectively. The results were compared.
Mean pulmonary blood flow was 0.63 mL/min/mL in the occluded segments versus 2.27 mL/min/mL in the nonoccluded segments (P: =.001). The sensitivity and specificity of perfusion maps for the presence of segmental pulmonary embolism compared with those of CT angiography were 75.4% and 82.3%, respectively, with positive and negative predictive values of 79.6% and 84.7%, respectively. The false-negative findings were caused mainly by partial occlusion of vessels. In eight patients, a substantial alternative or additional pathologic entity was diagnosed.
By combining CT angiography and dynamic CT imaging, a comprehensive and noninvasive diagnosis of thoracic structure and function is feasible with a single modality.
通过肺动脉计算机断层扫描（CT）血管造影结合血流功能CT成像，全面评估肺栓塞中的胸部解剖结构和肺微循环。
22例疑似急性肺栓塞患者接受了肺动脉对比剂增强薄层电子束CT血管造影。此外，对每位患者在7.6 cm肺容积上进行了动态多层面血流CT研究，并采用心电图门控。计算肺血流量，并在彩色编码图上显示灌注参数。两位阅片者分别独立地逐段评估彩色编码图和CT血管造影，以确定灌注缺损和血栓的存在情况。对结果进行比较。
闭塞节段的平均肺血流量为0.63 mL/（min·mL），而非闭塞节段为2.27 mL/（min·mL）（P = 0.001）。与CT血管造影相比，灌注图诊断节段性肺栓塞的敏感性和特异性分别为75.4%和82.3%，阳性预测值和阴性预测值分别为79.6%和84.7%。假阴性结果主要由血管部分闭塞引起。8例患者诊断出了重要的其他或额外病理实体。
通过结合CT血管造影和动态CT成像，采用单一模式对胸部结构和功能进行全面无创诊断是可行的。
