The Research Of Pulmonary Embolism In MSCT Appearence: Follow-up Clinical Therapy

Objective To find the chang rule of MSCT in post-therapy of pulmonaryembolism, by observing the CT appearance before and after thrombolysis oranticoagulation therapy. Materials and methods 100 patients suspected PE in NO.1affiliated hospital of KunMing medical college from March 2004 to March 2007 werecollected.60 patients in them diagnosed as PE and doing more than two times MSCTscan were reviewed and analyzed. MSCT scans were assessed independently by tworadiologists who were a physician and a postgraduate. Study the direct and indirectsigns of pulmonary embolism of MSCT pulmonary angiography before and afterthrombolysis or anticoagulation therapy. Collected the clinical data of those patients.At last, used statistic software SPSS 11.5 to handle the data by using X~2 test. ResultsThere were 566 pulmonary arteries embolized were shown by MSCT pulmonaryangiography before therapy, the signs of PE including complete occlusion fillingdefect (206,36.4ï¼…), lumina abrupt stenosis or cut off type (25,4.4%), central typefilling defect(252,44.5ï¼…) and acute angle mural type filling defect(45,8ï¼…), bluntangle mural type filling defect(29,5.1ï¼…) honeycombed type filling defect(9,1.6ï¼…).There were 341 pulmonary arteries embolized were observed by MSCT pulmonaryangiography in post-therapy, the direct sign including complete occlusion fillingdefect (125,36.6ï¼…), lumina abrupt stenosis or cut off type (12,3.5ï¼…), central typefilling defect(142,41.6ï¼…) and acute angle mural type filling defect(18,5.3ï¼…),blunt angle mural type filling defect(38,11.2ï¼…), honeycombed type filling defect(6,1.8ï¼…).There were significant difference in direct sign of MSCTPA between pre-therapy topost-therapy (P=0.019). There were no significance difference between completeocclusion filling defect to honeycombed type filling defect, central type filling defect,acute angle mural type filling defect and acute angle mural type fillingdefect(P=0.861,0.632,0.164,0.525).There were significant difference in direct signbetween central type to blunt angle mural type(P=0.001). There were significantdifference in direct sign between angle mural type to blunt angle mural type(P=0.001).There were significant difference in direct sign between blunt angle mural type tolumina abrupt stenosis or cut off type (P=0.018). There were significant difference inindirect sign of MSCTPA between pre-therapeutic to post-therapetuic (P=-0.024).There were no significant difference in position of embolus between pre-therapeuticto post-therapetuic (P=0.279).The 60 cases were divided into three groups:acute PEgroup(36 cases,303 pulmonary arteries embolized),chronic PE group (10 cases,94pulmonary arteries embolized),acute+chronic PE group (14 cases,169 pulmonaryarteries embolized). There were Significance difference between acute PE group andchronic PE group in before and after therapy. There were no significance differencebetween acute PE group and acute+chronic PE group. There were no significancedifference either between chronic PE group and acute+chronic PE group. In 60 cases,34 cases belong to large area PE, 26 cases belong to non-large area PE. There were nosignificance difference between the large area PE and non-large area PE in before andafter therapy. Conclusions CT is of significant value in diagnosing PE, estimating theage of thrombi and guiding the clinical therapy. Observing central type filling defectand angle mural type filling defect belong to the acute PE appearance. The opinionwhich complete occlusion type filling defect occurred chronic PE is no accurate. Theindirect sign of PE in lung can't use to estimate the severity degree of PE. The acutePE therapeutic effect is better than chronic PE. The large area PE therapeutic effect is no betterthan the non-large area PE.