Remy-Jardin M, Remy J, Cauvain O, Petyt L, Wannebroucq J, Beregi J P
Department of Radiology, Hospital Calmette, Lille, France.
AJR Am J Roentgenol. 1995 Nov;165(5):1131-8. doi: 10.2214/ajr.165.5.7572490.
The purpose of this study was to evaluate the role of multiplanar two-dimensional (2D) reformations in the diagnosis of central pulmonary embolism with helical CT.
Thirty-five patients with suspected pulmonary embolism underwent contrast-enhanced helical CT of the pulmonary arterial tree. Two sets of images were analyzed: overlapped transverse sections and 2D reformatted images of 10 obliquely oriented arteries (intralobar pulmonary artery, A2, A4+5, A6, and A10 [A = artery]) selected on three-dimensional shaded surface displays of each pulmonary arterial tree.
Among the 20 patients with unequivocal central pulmonary emboli on transverse sections (group 1), 2D reformations enabled a more precise analysis of the extent of thromboembolic disease in 13 cases. These patients underwent no further diagnostic procedure. In six patients (group 2), transverse sections alone excluded central pulmonary embolism with angiographic (n = 2) or scintigraphic (n = 4) confirmation. No additional information was provided with the 2D reformations. In nine patients with an uncertain diagnosis of pulmonary embolism on transverse sections (group 3), 2D reformations enabled us to exclude central emboli in all the cases, with angiographic (n = 4) or scintigraphic (n = 5) confirmation. In groups 1 and 3, 2D reformations provided adequate visualization of obliquely oriented arteries (n = 30) and enabled assessment (n = 2) or exclusion (n = 28) of endovascular changes, a clear distinction between endoluminal and perivascular abnormalities (n = 7), or a precise evaluation of extensive mural thrombi (n = 6).
Our results show that 2D reformations enable confident exclusion of pulmonary embolism on inconclusive helical CT examinations and improve analysis of the extent of thromboembolic disease.
本研究旨在评估多平面二维（2D）重建在螺旋CT诊断中央型肺栓塞中的作用。
35例疑似肺栓塞患者接受了肺动脉树的对比增强螺旋CT检查。分析了两组图像：重叠横断面图像以及在每个肺动脉树的三维表面阴影显示上选择的10条斜向动脉（叶内肺动脉、A2、A4 + 5、A6和A10 [A = 动脉]）的2D重建图像。
在横断面显示明确中央型肺栓塞的20例患者（第1组）中，2D重建使13例患者能够更精确地分析血栓栓塞性疾病的范围。这些患者未进行进一步的诊断程序。在6例患者（第2组）中，仅横断面就排除了经血管造影（n = 2）或核素扫描（n = 4）证实的中央型肺栓塞。2D重建未提供额外信息。在横断面肺栓塞诊断不确定的9例患者（第3组）中，2D重建使我们能够在所有病例中排除中央型栓塞，经血管造影（n = 4）或核素扫描（n = 5）证实。在第1组和第3组中，2D重建能够充分显示斜向动脉（n = 30），并能够评估（n = 2）或排除（n = 28）血管内变化，清晰区分腔内和血管周围异常（n = 7），或精确评估广泛的壁内血栓（n = 6）。
我们的结果表明，2D重建能够在螺旋CT检查结果不确定时可靠地排除肺栓塞，并改善对血栓栓塞性疾病范围的分析。
