Correlation Of Acute And Chronic Pulmonary Embolism With CT Angiography

Pulmonary embolism (PE) is the third most common acute cardiovascular disease, after myocardial infarction and stroke. Acute and chronic PE is the same disease course, at same place differ stage two pattern of manifestation. PE is not a rare disease but it have higher misdiagnosis rate, conduct and actions a common, requently encountered and higher case-fatality disease which has became is a major public health problem to involve many subjects and domains of medical science. Since the year of 1992 admove single-detector CT angiographic, DSA and V/Q which techniques were the fist chose to diagnose PE have gradually exodus. multidetector-row computed tomographic pulmonary angiography to draw assistance from higher time,space and density resolution has became the focus. Original image to integrate multiplanar reconstructions not only to detect segmental and subsegmental pulmonary embolisms but also find lung parenchyma pleuralis,chambers heart and great vessels,bronchial arteries which has been encroached. At present, this directions have few report .Objective: through CTPA to differential diagnosis acute and chronic pulmonary embolism and analyses the problem of lung parenchyma pleuralis, chambers heart and great vessels,bronchial arteries discuss the pathogenesy Materials and Methods:Forty consecutive patients, most of them D-Dimer had determine positive,they clinical feature contains continuity dyspneic, chest pain, cough, Coughing up blood and carus; among the total 21 patients have VTE history, 4 patients had operation or trauma history in four weeks, 2 patients had post partum in four weeks, 1 patient have coronary artery disease history, 16 patients smoking; including 15 patients (nine men, six women; mean age, 60.0 years) with chronic pulmonary embolism and 25 patients (17men, 8 women; mean age, 47.0years) with Acute pulmonary embolism, control group15 patients without the heart and lung disease (6 men, 9 women; mean age, 42.0 years) underwent 16-slice CT angiography of the pulmonary. All CT data were obtained with a sixteen-channel multi–detector row CT scanner (LightSpeed; General Electric Medical System). All the subjects fasted 4-6 hours, when the sensitivity test showed negative, the venous channel was established through the antecubital vein, non-iodic ion contrast agent,whose iodine content is 300mg/l, was injected by automatic high pressure injector with speed of 4ml/s and total dose of 90ml and normal saline 20ml. after that we collected the data at 18-22s.X-ray tube voltage, tube current, and gantry rotation time for all scans were 120-140 kV, 300-350 mA, and 0.8 second per rotation respectively.Through observation axial images combination multiplanar reconstructions VR,MIP,MPR analysis APE/CPE and control group whom pulmonary artery tree anatomy, surveying position and shape of the embolus,observation on RV/LV and dilation degree of bronchial artery, then differential diagnosis of pulmonary hypertension, evaluate the prognosis of the patients.Result:1. 16-slice CT could suffice discover 1-5 degree pulmonary artery embolus, comparison with APE and CPE,CPE have more emboli and wide distribution, group comparison have statistical significance P<0.05.2. CTPA can display pulmonary artery tree and measure diameter, APE group compare control group, *P<0.01; CPE group compare with control group, , P<0.05, APE group compare CPE group,△P<0.01.3. Evaluation bronchial artery, APE group compare with CPE group for discover dilat, lumens diameter and secar have statistical significance P<0.01.4. Evaluation RV/LV and right ventricular wall thickness, APE group compare with CPE group have statistical significance P<0.01.With the above studies and analysis, the following conclusions were shown bellow.CTPA can detect embolus in endovascular and multiplanar reconstructions VR,MIP,MPR can objective description embolus shape,size, location, through display dilated bronchial artery can differential diagnosis of pulmonary hypertension,then RV/LV>1 suggested that have severity PE. comprehensive observation above indexes can reasonable explanation when treatment process observe a series of pathophysiological, can evaluate prognosis, for clinical choose treatment methods has important significance.