目的探讨双源CT肺灌注血池容积技术对于肺分支小血管栓塞的量化及诊断价值。方法对55例临床诊断为肺栓塞患者进行CT肺动脉造影（CTPA）及肺灌注血池容积（PBV）成像，所得图像以肺段为评价单位，分别对CTPA血管内栓子数量、位置、栓塞程度、PBV灌注减低区范围、平均CT值及碘含量值进行比较，分析其统计学差异。结果55例患者除3例有不同程度支气管炎、肺气肿、肺间质纤维化或胸腔积液，双肺表现为弥漫性灌注降低，未纳入统计，其余共有832个肺段和肺段动脉纳入分析。其中197个肺段内有栓子存在。以肺段为评价单位，PBV共检出179个肺段有灌注减低，与CTPA检出197个栓子的符合率为90.8%。肺栓塞与无肺栓塞病变区域的CT值及PBV碘含量差异具有统计学意义（均P＜0.01），而完全性肺栓塞与不完全肺栓塞上述两指标差异无统计学意义（均P＞0.05）。其中8.9%（16/179）肺段远端肺实质内出现与栓塞程度不符的灌注减低，3.9%（7/179）肺段出现CTPA初期漏诊的情况。结论双源CT肺灌注血池容积技术避免了CTPA假阴性的可能，明显提高肺分支小血管栓塞的检出率。%Objective To assess the diagnostic value and quantification of lung perfusion blood volume by dual- energy CT in patients with pulmonary subbranches embolism. Methods 55 clinical patients with acute pulmonary embolism underwent dual- ennergy imaging,the images were evaluated with lung PBV software on the syngovia workstation,after CT pulmonary an-giography (CTPA). Al images were based on subbranches,the number location and embolism proportion of PE in CTPA and PBV range、average CT value and lodine value were recorded and analyzed. Results 832 subbranches were recorded and analyzed except 3 patients with branches phlegmonosis, pulmonary emphysema, pulmonary fibrosis or pleural effusion. 197 subbranches were involved with pulmonary embolism, basing on subbranches, 90.8% agreement between CTPA (197) and PBV (179),There was a significant difference statistical y in PBV between patients with and without pulmonary subbranches embolism (P<0.01). There was no significant difference statistical y in embolism proportion(P>0.05), 8.9%(16/179)PBV on subbranches showed de-creased perfusion which disagree with embolism proportion in CTPA,3.9%(7/179) CTPA showed preliminary missed diagnosis. Conclusion Lung perfusion blood volume by dual- energy CT avoid false negative results in CTPA, improve the detection rate in pulmonary subbranches embolism obviously.
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