体-肺分流下肺结核患者假性肺栓塞双期计算机断层扫描血管造影的影像特征分析

doi:10.19982/j.issn.1000-6621.20260089

摘要/Abstract

摘要：

目的: 探讨支气管体-肺动脉分流(bronchial-pulmonary shunts, BPS)因素影响下,肺结核假性肺动脉栓塞(pulmonary embolism, PE)患者肺动脉-支气管动脉双期计算机断层扫描血管造影(computed tomography angiography, CTA)的影像学特征,以提高假性PE的诊断水平。方法: 回顾性收集安徽省胸科医院2017年8月至2025年1月诊治的51例肺结核伴假性PE患者的临床资料,选取同时期符合纳入和排除标准的肺结核伴真性PE患者51例,对比分析两组患者双期CTA影像特征。利用容积再现(volume rendering, VR)、最大密度投影(maximum intensity projection, MIP)等后处理技术,评价假性PE双期CTA异常肺动脉充盈状态、数量及分布,同时观察相关扩张扭曲支气管动脉情况。结果: 假性PE组患者咯血检出率为47.1%(24/51),明显高于真性PE组15.7%(8/51),差异有统计学意义(χ²=11.657,P=0.001)。假性PE组患者肺内病变CT表现为毁损肺、肺叶/段萎缩的检出率分别为47.1%(24/51)、33.3%(17/51),均高于真性PE组[分别为15.7%(8/51)、11.8%(6/51)],差异均有统计学意义(χ²=11.657,P=0.001;χ²=6.793,P=0.009)。假性PE组肺动脉期CTA发现叶/段及以上异常充盈肺动脉55支、支气管动脉期CTA均表现为造影剂错期充盈;真性PE组肺动脉期CTA发现叶/段及以上充盈缺损肺动脉95支、支气管动脉期CTA均未见造影剂充盈;假性PE组双期异常肺动脉CT值中位数(四分位数)分别为178.00(94.00,250.00)HU、412.00(337.00,462.00)HU,均明显高于真性PE组[57.00(48.00,69.00)HU、59.00(50.00,70.00)HU],差异均有统计学意义(Z=-9.330,P<0.001;Z=-10.192,P<0.001)。55支假性PE肺动脉期CTA表现为充盈缺损46支(83.6%,46/55)、充盈不佳9支(16.4%,9/55),同时支气管动脉期CTA发现相关扭曲扩张支气管动脉69支,提示为BPS导致的假性PE。假性PE分布于上叶肺动脉42支(76.4%,42/55)、右肺动脉4支(7.3%,4/55)、左肺动脉6支(10.9%,6/55)、左肺下叶肺动脉3支(5.4%,3/55)。结论: 存在BPS的肺结核患者假性PE的肺动脉-支气管动脉双期CTA影像表现具有特征性,有效掌握影像学特点能为临床早期诊治提供帮助。

关键词: 体-肺动脉分流, 肺栓塞, 结核, 肺, 肺动脉, 血管造影术

Abstract:

Objective: To investigate the imaging characteristics of pulmonary artery-bronchial artery dual-phase computed tomography angiography (CTA) in patients with pulmonary tuberculosis pseudo pulmonary embolism (PE) under the influence of bronchial-pulmonary shunt (BPS), in order to improve the diagnosis of pseudo-PE. Methods: A retrospective study was conducted on clinical data of 51 patients with pulmonary tuberculosis and pseudo-PE diagnosed and treated at Anhui Chest Hospital from August 2017 to January 2025. Fifty-one patients with pulmonary tuberculosis and true PE during the same period were selected as controls. The imaging features of dual-phase CTA in these two groups were compared and analyzed. Post-processing techniques including volume rendering (VR) and maximum intensity projection (MIP) were used to evaluate the status, quantity, and distribution of abnormal pulmonary artery filling on dualphase CTA in pseudoPE patients, and to observe the associated dilation and twisting of bronchial arteries. Results: The detection rate of hemoptysis in the pseudo-PE group was 47.1% (24/51), significantly higher than that in the true PE group (15.7%, 8/51; χ²=11.657, P=0.001). In the pseudo-PE group, the detection rates of destroyed lung and lobar/segmental atrophy in intrapulmonary lesions on CT were 47.1% (24/51) and 33.3% (17/51), respectively, significantly higher than those in the true PE group (15.7% (8/51) and 11.8% (6/51), respectively; χ²=11.657, P=0.001; χ²=6.793, P=0.009). In the pseudo-PE group, 55 pulmonary arteries at the lobar/segmental level or above exhibited abnormal filling on pulmonary arterial-phase CTA, and all showed delayed contrast agent filling on bronchial arterial-phase CTA. In the true PE group, 95 pulmonary arteries at the lobar/segmental level or above showed filling defects on pulmonary arterial-phase CTA, with no contrast opacification observed on bronchial arterial-phase CTA. The median CT values of abnormal pulmonary arteries on dualphase CTA in the pseudo-PE group were 178.00 (94.00, 250.00) HU and 412.00 (337.00, 462.00) HU, respectively, which were significantly higher than those in the true PE group (57.00 (48.00, 69.00) HU and 59.00 (50.00, 70.00) HU, respectively; Z=―9.330, P<0.001; Z=―10.192, P<0.001). Among the 55 pseudo-PE pulmonary arteries on pulmonary arterial phase CTA, 46 (83.6%, 46/55) showed filling defects and 9 (16.4%, 9/55) showed poor filling. Meanwhile, 69 associated tortuous and dilated bronchial arteries were detected on bronchial arterial-phase CTA, indicating pseudo-PE secondary to bronchial-pulmonary shunts (BPS). The pseudo-PE lesions involved 42 (76.4%, 42/55) upper lobe pulmonary arteries, 4 (7.3%, 4/55) right pulmonary arteries, 6 (10.9%, 6/55) left pulmonary arteries, and 3 (5.4%, 3/55) left lower lobe pulmonary arteries. Conclusion: In patients with pulmonary tuberculosis and BPS, pseudo-PE exhibits certain characteristics on pulmonary artery-bronchial artery dual-phase CTA. Effectively identifying its imaging features can provide assistance for early clinical diagnosis and treatment.

Key words: Bronchial-pulmonary shunts, Pulmonary embolism, Tuberculosis, pulmonary, Pulmonary artery, Angiography

中图分类号:

R521
R445

郭金龙, 闵旭红, 宋彪, 李源, 王尚虎, 陈武. 体-肺分流下肺结核患者假性肺栓塞双期计算机断层扫描血管造影的影像特征分析[J]. 中国防痨杂志, 2026, 48(8): 1192-1198. doi: 10.19982/j.issn.1000-6621.20260089

Guo Jinlong, Min Xuhong, Song Biao, Li Yuan, Wang Shanghu, Chen Wu. Imaging feature analysis of pseudo-pulmonary embolism on dual-phase computed tomography angiography in pulmonary tuberculosis patients with bronchial-pulmonary shunts[J]. Chinese Journal of Antituberculosis, 2026, 48(8): 1192-1198. doi: 10.19982/j.issn.1000-6621.20260089

图/表 5

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CT征象	假性PE组(51例)	真性PE组(51例)	χ²值	P值
结节影	36(70.6)	37(72.5)	0.048	0.826
团块影	9(17.6)	6(11.8)	0.703	0.402
继发空洞	17(33.3)	19(37.3)	0.172	0.679
支气管扩张	24(47.1)	22(43.1)	0.158	0.691
毁损肺	24(47.1)	8(15.7)	11.657	0.001
肺叶/段萎缩	17(33.3)	6(11.8)	6.793	0.009
干酪性肺炎	4(7.8)	6(11.8)	-	0.741^a
气管及支气管结核	15(29.4)	17(33.3)	0.182	0.670
结核性胸膜炎	21(41.2)	18(35.3)	0.374	0.541