肺动脉栓塞的实验及临床研究
|
摘要
目的：1.运用介入栓塞技术建立一种能用于影像学诊断的猪急性亚段肺动脉栓塞模型，并评价其技术上的可行性和准确性；2.比较多层螺旋CT肺动脉造影不同层厚对亚段肺动脉栓塞的显示能力；3.以肺动脉血管铸型标本为金标准，比较多层螺旋CT肺动脉造影、数字减影X线肺动脉造影对亚段肺动脉栓塞的显示能力。
方法：1.8只家猪经右侧颈外静脉注入若干聚氯乙烯（PVC）栓塞剂（直径2-3mm），栓塞前后分别做DSPA和CTPA。栓塞成功后24小时内处死动物，取出完整猪肺组织。经肺动脉主干注入适量铸型剂（32.8％树脂溶液）行血管铸型；2.8只家猪，均用1.0mm准直扫描进行CT肺动脉造影，分别用1.0mm/0.5mm（层厚/层间距）（A组）,2.0mm/1.0mm（B组）,3.0mm/1.5mm（C组）重建，记录每只家猪3种不同重建层厚显示亚段肺动脉栓塞的敏感性和阳性预测值；3.8只家猪，分别进行数字减影X线肺动脉造影、多层螺旋CT肺动脉造影和肺动脉血管铸型，多层螺旋CT肺动脉造影图像分别用1mm、2mm、3mm层厚重建，记录每只家猪3种不同方法检测亚段肺动脉栓子的敏感性和阳性预测值。
结果：1.8只猪全部成功制作急性亚段肺动脉栓塞模型，在DSPA图像上，亚段肺动脉栓塞表现为相应区域的肺动脉分支数减少；在CTPA图像上，亚段肺动脉栓塞表现为相应肺动脉内的充盈缺损；血管铸型标本上可见相应肺动脉内有栓塞剂，远端分支中断；2. A,B,C组数据显示亚段肺动脉栓塞的敏感性和95％可信区间分别为93.02％（82.45-101.43％），83.72％（74.69-91.75％），83.72％（75.69-91.19％），3组间无显著性差异(P>0.05)。A,B,C组数据显示亚段肺动脉栓塞的阳性预测值和95％可信区间分别为78.43%(66.41-88.95%),83.72%(80.92-87.15%),90.00%(81.65-97.52%)，A组与C组间有显著性差异(P <0.05)，B组与A组和C组均无显著性差异(P>0.05)；3.不同方法显示亚段肺动脉栓子敏感性分别为88%(95%CI,86-90%)(DSPA组)，93％（95%CI,88-97%）（CTPA1mm组）,85％（95%CI,81-89％）（CTPA2mm组），85％（95%CI,82-89％）（CTPA3mm组）。数字减影X线肺动脉造影、多层螺旋CT肺动脉造影诊断亚段肺动脉栓子的敏感性没有显著性差异（P>0.05），CTPA1mm层厚组敏感性高于2mm和3mm组（P<0.05）。不同方法显示亚段肺动脉栓子阳性预测值分别为82%(95%CI,80-86%)(DSPA组)，82％（95%CI,75-87%）（CTPA1mm组）,84％（95%CI,81-87％）（CTPA2mm组），88％（95%CI,84-92％）（CTPA3mm组）。数字减影X线肺动脉造影、多层螺旋CT肺动脉造影诊断亚段肺动脉栓子的阳性预测值没有显著性差异（P>0.05）。肺动脉血管铸型标本栓子检出率最高，达100％。
结论：1.介入栓塞技术制作猪急性亚段肺动脉栓塞模型具有操作简单，栓塞可靠，创伤小易存活等优点，为亚段肺动脉栓塞早期诊断和治疗的研究提供了一种理想的方法；2.多层螺旋CT肺动脉造影1.0mm、2.0mm、3.0mm重建层厚对亚段肺动脉栓塞均有良好的显示率，可作为四层和四层以上螺旋CT肺动脉造影的成像参数；3.数字减影X线肺动脉造影、多层螺旋CT肺动脉造影对于急性亚段肺动脉栓塞的诊断没有显著性差异；多层螺旋CT肺动脉造影可以取代数字减影X线肺动脉造影，成为急性肺动脉栓塞诊断的首选且可靠的检查方法。
目的：评估Qanadli CT阻塞指数在定量分析肺动脉栓塞(PE)患者治疗效果中的价值。
方法：多层螺旋CT血管成像（CTA）确诊、经溶栓或（及）抗凝治疗并治疗后以CTA随访的患者55例，随访时间为1-6周。治疗前后采用Qanadli栓塞指数评价肺动脉阻塞程度，并记录临床指征（血氧饱和度及肺动脉压）在治疗前后的变化值。采用spearman等级相关系数评价其与血氧饱和度及肺动脉压恢复的相关性。
结果：55例患者中，51例经溶栓或（及）抗凝治疗后临床指征明显改善，血氧饱和度由(83.52±4.461)%上升到(94.76±3.532)%（p<0.001），肺动脉压力由(31.17±5.892)mmHg下降至(19.83±4.804)mmHg（p<0.001）； Qanadli栓塞指数从治疗前的(45.09±18.22)%降至治疗后的(10.86±10.29)%（P＜0.001）。4例患者临床指征改善不明显，Qanadli栓塞指数治疗前后未见显著统计学差异（P=0.080）。治疗前后Qanadli栓塞指数与血氧饱和度、肺动脉压力的差异度均存在良好相关性（r值分别为0.934、0.813）。
结论：Qanadli栓塞指数可方便、准确用于肺动脉栓塞治疗效果的定量评估，可作为临床疗效评估的随访指标之一。
目的：评价CT肺动脉造影(CTPA)栓塞指数在指导和检测经皮导管碎栓治疗急性大面积肺动脉栓塞中的作用。
方法：自2003年1月至2009年12月，35例患者由CTPA诊断为急性大块状肺动脉栓塞（T0），并经用导管进行碎栓治疗。肺栓的严重程度由CT栓塞指数（(Qanadli index)评价并对比血管造影栓塞指数（Miller index）。CTPA，血氧饱和度(SaO2)及肺动脉压（PAP）被作为随访指标。
结果：平均CT栓塞指数（(Qanadli index)为55%±13%(range,40%–75%)，血管造影栓塞指数（Miller index）为62%±15%(range,45%–85%)，两者之间有显著相关性(r=0.867, p <0.0001)。在33个患者中CT栓塞指数（Qanadliindex)治疗后显示明显下降(T0:55%±13%; T1:12%±10%%;p<0.001)。CT栓塞指数（(Qanadli index)与血氧饱和度（SaO2，r=0.895)及肺动脉压（PAP，r=0.827)之间有显著相关性。
结论：CT栓塞指数（(Qanadli index)在区分大面积和次大面积肺动脉栓塞上提供了一种较准确的方法，它可用于决定治疗的选择及检测临床治疗结果。
Objectives:1.To establish a porcine model of acute subsegmental pulmonary embolism which is suitable to study imaging diagnosis and to evaluate the techniquefeasibility and stability;2.To compare the visibility of subsegmental pulmonaryemboli by different slice thickness reconstruction using multislice spiral CTpulmonary angiography.3.To compare multislice spiral CT to digital subtractpulmonary angiography for the detection of subsegmental pulmonary emboli by usinga cast of porcine pulmonary vessels as an independent gold standard.
Methods:1. Some polyvinyl chloride emboli (the diameter of the emboli was2-3mm)were injected into the right external jugular vein in eight porcines. DSPAand CTPA were performed respectively before and after pulmonary embolism. Theseporcine were put to death after pulmonary embolism within24hours. The pulmonarycasts were made of porcine lungs in vitro by using some resin, of which theconcentration was about32.8%.2.8porcine were underwent CT pulmonaryangiography with1.0mm collimation. Three different slice thickness werereconstructed from the raw data for each porcine:1.0mm/0.5mm(slice thickness/increment,group A),2.0mm/1.0mm(group B),3.0mm/1.5mm(group C).Thesensitivity and positive predictive value of subsegmental pulmonary emboli in the3groups were recorded.3.8porcine were underwent digital substract pulmonaryangiography, multislice spiral CT pulmonary angiography and pulmonary vessel castrespectively. The sensitivity and positive predictive value of subsegmental pulmonaryemboli in3different methods were counted.
Results:1. The model of acute subsegmental pulmonary embolism was establishedsuccessfully with all8porcine.The obliteration of the subsegmental pulmonaryarterial branches was seen on the images of DSPA. The filling defect was seen in thesubsegmental pulmonary arteries on CTPA. And the polyvinyl chloride emboliwere found in the subsegmental pulmonary arteries of the pulmonary casts.2. Thesensitivity and its95%confidence interval of subsegmental pulmonary embolism in group A,B and C was93.02％（95%CI,82.45-101.43％），83.72％（95%CI,74.69-91.75％），83.72％（95%CI,75.69-91.19％）,respectively. There wereno significant differences among3groups(P>0.05).The positive predictive value andits95%confidence interval of subsegmental pulmonary embolism in group A,B and C was78.43%(95%CI,66.41-88.95%),83.72%(95%CI,80.92-87.15%),90.00%(95%CI,81.65-97.52%). There was significant difference between A and C (P<0.05). There wasno significant difference between A and B or between B and C (P>0.05).3. Sensitivityfor multislice spiral CT and angiography respectively were:88%(95%CI,86-90%)(DSPA group)，93％（95%CI,88-97%）（CTPA1mm group）,85％（95%CI,81-89％）（CTPA2mm group），85％（95%CI,82-89％）（CTPA3mm group）(p>0.05).Positive predictive values for multislice spiral CT and angiographyrespectively were82%(95%CI,80-86%)(DSPA group)，82％（95%CI,75-87%）（CTPA1mm group）,84％（95%CI,81-87％）（CTPA2mm group），88％（95%CI,84-92％）（CTPA3mm group）(p>0.05).There was no difference betweenmultislice spiral CT and angiography for detection of subsegmental pulmonaryemboli.
Conclusions:1. The model of acute subsegmental pulmonary embolism in porcineswith interventional technique is simple, reliable and microinvasive.The method doesserve as a useful model for the early medical imaging diagnosis and therapy of acutesubsegmental pulmonary embolism.2. Multislice spiral CT pulmonary angiographywith reconstructed slice thickness of1.0mm,2.0mm,3.0mm is enabled todemonstrate subsegmental pulmonary emboli, which should be the parameters of4-slice and more than4-slice spiral CT.3. Multislice spiral CT is comparable toangiography for the diagnosis of pulmonary embolism. Multislice spiral CT canreplace conventional pulmonary angiography, used as the firstline reliable examination of pulmonary embolism.
Objectives: To quantitively evaluate the value of computed tomography(CT)obstruction index described by Qanadli et al in monitoring the outcomes of pulmonary embolism (PE) undertaken thrombolysis and(or) anticoagulation.
Methods: Fifty-five consecutive patients (mean age57.5years) diagnosed as PE bycomputed tomography angiography (CTA) at the initial time(T0) were selected in thisstudy. All the patients were treated with thrombolysis and (or) anticoagulation. CTAwas performed again as the follow-up evaluation (T1) with the mean interval time1-6weeks after therapy. Qanadli obstruction index was calculated at both T0and T1.Other follow-up evaluation included oxygen saturation （Sat. O2）and pulmonaryartery pressure（PAP）.
Results: The improvements of Sat. O2and PAP immediately occurred in51of55patients after thrombolysis and(or) anticoagulation therapy. Qanadli obstruction indexin the51patients decreased from45.09%±18.22to10.86%±10.29at T0and T1respectively with statistically significant difference （P<0.001). No statisticalsignificance of Qanadli obstruction index between T0and T1（P=0.080）was found inthe rest four patients without improvement of Sat. O2and PAP. Significantcorrelations existed between Qanadli obstruction index and Sat. O2(r=0.934), as wellas CT obstruction index and PAP(r=0.813).
Conclusion: Qanadli obstruction index is an accurate, convenient, and repeatable toolin quantitively evaluating therapeutic outcomes of pulmonary embolism (PE) withmanagement of thrombolysis and(or) anticoagulation.
Objectives: To assess value of computed tomography pulmonary angiography(CTPA)in guiding therapeutic decisions and monitoring patients undertaken percutaneous catheter fragment for acute massive pulmonary embolism (PE).
Methods：From Jan2003to Dec2009,35patients were diagnosised as acute massivePE by CTPA (T0) and treated with percutaneous catheter fragmentation. The severitywas assessed by CT obstruction index (Qanadli index) and compared with Millerindex. CTPA, Oxygen saturation(SaO2) and pulmonary artery pressure(PAP) wereperformed as follow-up index.
Results: The mean percentage of Qanadli index was55%±13%(range,40%–75%),Miller index was62%±15%(range,45%–85%). Correlations between them werestatistically significant (r=0.867, p <0.0001). Qanadli index showed significantreduction (T0:55%±13%; T1:12%±10%%;p<0.001) in33patients. Significantcorrelation was observed between Qanadli index and SaO2(r=0.895),PAP(r=0.827).
Conclusion: Qanadli index provides an accurate method to distinguish massive PEfrom sub-massive PE. It can be used to determine therapeutic options and monitorclinical outcomes.
方法：1.8只家猪经右侧颈外静脉注入若干聚氯乙烯（PVC）栓塞剂（直径2-3mm），栓塞前后分别做DSPA和CTPA。栓塞成功后24小时内处死动物，取出完整猪肺组织。经肺动脉主干注入适量铸型剂（32.8％树脂溶液）行血管铸型；2.8只家猪，均用1.0mm准直扫描进行CT肺动脉造影，分别用1.0mm/0.5mm（层厚/层间距）（A组）,2.0mm/1.0mm（B组）,3.0mm/1.5mm（C组）重建，记录每只家猪3种不同重建层厚显示亚段肺动脉栓塞的敏感性和阳性预测值；3.8只家猪，分别进行数字减影X线肺动脉造影、多层螺旋CT肺动脉造影和肺动脉血管铸型，多层螺旋CT肺动脉造影图像分别用1mm、2mm、3mm层厚重建，记录每只家猪3种不同方法检测亚段肺动脉栓子的敏感性和阳性预测值。
结果：1.8只猪全部成功制作急性亚段肺动脉栓塞模型，在DSPA图像上，亚段肺动脉栓塞表现为相应区域的肺动脉分支数减少；在CTPA图像上，亚段肺动脉栓塞表现为相应肺动脉内的充盈缺损；血管铸型标本上可见相应肺动脉内有栓塞剂，远端分支中断；2. A,B,C组数据显示亚段肺动脉栓塞的敏感性和95％可信区间分别为93.02％（82.45-101.43％），83.72％（74.69-91.75％），83.72％（75.69-91.19％），3组间无显著性差异(P>0.05)。A,B,C组数据显示亚段肺动脉栓塞的阳性预测值和95％可信区间分别为78.43%(66.41-88.95%),83.72%(80.92-87.15%),90.00%(81.65-97.52%)，A组与C组间有显著性差异(P <0.05)，B组与A组和C组均无显著性差异(P>0.05)；3.不同方法显示亚段肺动脉栓子敏感性分别为88%(95%CI,86-90%)(DSPA组)，93％（95%CI,88-97%）（CTPA1mm组）,85％（95%CI,81-89％）（CTPA2mm组），85％（95%CI,82-89％）（CTPA3mm组）。数字减影X线肺动脉造影、多层螺旋CT肺动脉造影诊断亚段肺动脉栓子的敏感性没有显著性差异（P>0.05），CTPA1mm层厚组敏感性高于2mm和3mm组（P<0.05）。不同方法显示亚段肺动脉栓子阳性预测值分别为82%(95%CI,80-86%)(DSPA组)，82％（95%CI,75-87%）（CTPA1mm组）,84％（95%CI,81-87％）（CTPA2mm组），88％（95%CI,84-92％）（CTPA3mm组）。数字减影X线肺动脉造影、多层螺旋CT肺动脉造影诊断亚段肺动脉栓子的阳性预测值没有显著性差异（P>0.05）。肺动脉血管铸型标本栓子检出率最高，达100％。
结论：1.介入栓塞技术制作猪急性亚段肺动脉栓塞模型具有操作简单，栓塞可靠，创伤小易存活等优点，为亚段肺动脉栓塞早期诊断和治疗的研究提供了一种理想的方法；2.多层螺旋CT肺动脉造影1.0mm、2.0mm、3.0mm重建层厚对亚段肺动脉栓塞均有良好的显示率，可作为四层和四层以上螺旋CT肺动脉造影的成像参数；3.数字减影X线肺动脉造影、多层螺旋CT肺动脉造影对于急性亚段肺动脉栓塞的诊断没有显著性差异；多层螺旋CT肺动脉造影可以取代数字减影X线肺动脉造影，成为急性肺动脉栓塞诊断的首选且可靠的检查方法。
目的：评估Qanadli CT阻塞指数在定量分析肺动脉栓塞(PE)患者治疗效果中的价值。
方法：多层螺旋CT血管成像（CTA）确诊、经溶栓或（及）抗凝治疗并治疗后以CTA随访的患者55例，随访时间为1-6周。治疗前后采用Qanadli栓塞指数评价肺动脉阻塞程度，并记录临床指征（血氧饱和度及肺动脉压）在治疗前后的变化值。采用spearman等级相关系数评价其与血氧饱和度及肺动脉压恢复的相关性。
结果：55例患者中，51例经溶栓或（及）抗凝治疗后临床指征明显改善，血氧饱和度由(83.52±4.461)%上升到(94.76±3.532)%（p<0.001），肺动脉压力由(31.17±5.892)mmHg下降至(19.83±4.804)mmHg（p<0.001）； Qanadli栓塞指数从治疗前的(45.09±18.22)%降至治疗后的(10.86±10.29)%（P＜0.001）。4例患者临床指征改善不明显，Qanadli栓塞指数治疗前后未见显著统计学差异（P=0.080）。治疗前后Qanadli栓塞指数与血氧饱和度、肺动脉压力的差异度均存在良好相关性（r值分别为0.934、0.813）。
结论：Qanadli栓塞指数可方便、准确用于肺动脉栓塞治疗效果的定量评估，可作为临床疗效评估的随访指标之一。
目的：评价CT肺动脉造影(CTPA)栓塞指数在指导和检测经皮导管碎栓治疗急性大面积肺动脉栓塞中的作用。
方法：自2003年1月至2009年12月，35例患者由CTPA诊断为急性大块状肺动脉栓塞（T0），并经用导管进行碎栓治疗。肺栓的严重程度由CT栓塞指数（(Qanadli index)评价并对比血管造影栓塞指数（Miller index）。CTPA，血氧饱和度(SaO2)及肺动脉压（PAP）被作为随访指标。
结果：平均CT栓塞指数（(Qanadli index)为55%±13%(range,40%–75%)，血管造影栓塞指数（Miller index）为62%±15%(range,45%–85%)，两者之间有显著相关性(r=0.867, p <0.0001)。在33个患者中CT栓塞指数（Qanadliindex)治疗后显示明显下降(T0:55%±13%; T1:12%±10%%;p<0.001)。CT栓塞指数（(Qanadli index)与血氧饱和度（SaO2，r=0.895)及肺动脉压（PAP，r=0.827)之间有显著相关性。
结论：CT栓塞指数（(Qanadli index)在区分大面积和次大面积肺动脉栓塞上提供了一种较准确的方法，它可用于决定治疗的选择及检测临床治疗结果。
Objectives:1.To establish a porcine model of acute subsegmental pulmonary embolism which is suitable to study imaging diagnosis and to evaluate the techniquefeasibility and stability;2.To compare the visibility of subsegmental pulmonaryemboli by different slice thickness reconstruction using multislice spiral CTpulmonary angiography.3.To compare multislice spiral CT to digital subtractpulmonary angiography for the detection of subsegmental pulmonary emboli by usinga cast of porcine pulmonary vessels as an independent gold standard.
Methods:1. Some polyvinyl chloride emboli (the diameter of the emboli was2-3mm)were injected into the right external jugular vein in eight porcines. DSPAand CTPA were performed respectively before and after pulmonary embolism. Theseporcine were put to death after pulmonary embolism within24hours. The pulmonarycasts were made of porcine lungs in vitro by using some resin, of which theconcentration was about32.8%.2.8porcine were underwent CT pulmonaryangiography with1.0mm collimation. Three different slice thickness werereconstructed from the raw data for each porcine:1.0mm/0.5mm(slice thickness/increment,group A),2.0mm/1.0mm(group B),3.0mm/1.5mm(group C).Thesensitivity and positive predictive value of subsegmental pulmonary emboli in the3groups were recorded.3.8porcine were underwent digital substract pulmonaryangiography, multislice spiral CT pulmonary angiography and pulmonary vessel castrespectively. The sensitivity and positive predictive value of subsegmental pulmonaryemboli in3different methods were counted.
Results:1. The model of acute subsegmental pulmonary embolism was establishedsuccessfully with all8porcine.The obliteration of the subsegmental pulmonaryarterial branches was seen on the images of DSPA. The filling defect was seen in thesubsegmental pulmonary arteries on CTPA. And the polyvinyl chloride emboliwere found in the subsegmental pulmonary arteries of the pulmonary casts.2. Thesensitivity and its95%confidence interval of subsegmental pulmonary embolism in group A,B and C was93.02％（95%CI,82.45-101.43％），83.72％（95%CI,74.69-91.75％），83.72％（95%CI,75.69-91.19％）,respectively. There wereno significant differences among3groups(P>0.05).The positive predictive value andits95%confidence interval of subsegmental pulmonary embolism in group A,B and C was78.43%(95%CI,66.41-88.95%),83.72%(95%CI,80.92-87.15%),90.00%(95%CI,81.65-97.52%). There was significant difference between A and C (P<0.05). There wasno significant difference between A and B or between B and C (P>0.05).3. Sensitivityfor multislice spiral CT and angiography respectively were:88%(95%CI,86-90%)(DSPA group)，93％（95%CI,88-97%）（CTPA1mm group）,85％（95%CI,81-89％）（CTPA2mm group），85％（95%CI,82-89％）（CTPA3mm group）(p>0.05).Positive predictive values for multislice spiral CT and angiographyrespectively were82%(95%CI,80-86%)(DSPA group)，82％（95%CI,75-87%）（CTPA1mm group）,84％（95%CI,81-87％）（CTPA2mm group），88％（95%CI,84-92％）（CTPA3mm group）(p>0.05).There was no difference betweenmultislice spiral CT and angiography for detection of subsegmental pulmonaryemboli.
Conclusions:1. The model of acute subsegmental pulmonary embolism in porcineswith interventional technique is simple, reliable and microinvasive.The method doesserve as a useful model for the early medical imaging diagnosis and therapy of acutesubsegmental pulmonary embolism.2. Multislice spiral CT pulmonary angiographywith reconstructed slice thickness of1.0mm,2.0mm,3.0mm is enabled todemonstrate subsegmental pulmonary emboli, which should be the parameters of4-slice and more than4-slice spiral CT.3. Multislice spiral CT is comparable toangiography for the diagnosis of pulmonary embolism. Multislice spiral CT canreplace conventional pulmonary angiography, used as the firstline reliable examination of pulmonary embolism.
Objectives: To quantitively evaluate the value of computed tomography(CT)obstruction index described by Qanadli et al in monitoring the outcomes of pulmonary embolism (PE) undertaken thrombolysis and(or) anticoagulation.
Methods: Fifty-five consecutive patients (mean age57.5years) diagnosed as PE bycomputed tomography angiography (CTA) at the initial time(T0) were selected in thisstudy. All the patients were treated with thrombolysis and (or) anticoagulation. CTAwas performed again as the follow-up evaluation (T1) with the mean interval time1-6weeks after therapy. Qanadli obstruction index was calculated at both T0and T1.Other follow-up evaluation included oxygen saturation （Sat. O2）and pulmonaryartery pressure（PAP）.
Results: The improvements of Sat. O2and PAP immediately occurred in51of55patients after thrombolysis and(or) anticoagulation therapy. Qanadli obstruction indexin the51patients decreased from45.09%±18.22to10.86%±10.29at T0and T1respectively with statistically significant difference （P<0.001). No statisticalsignificance of Qanadli obstruction index between T0and T1（P=0.080）was found inthe rest four patients without improvement of Sat. O2and PAP. Significantcorrelations existed between Qanadli obstruction index and Sat. O2(r=0.934), as wellas CT obstruction index and PAP(r=0.813).
Conclusion: Qanadli obstruction index is an accurate, convenient, and repeatable toolin quantitively evaluating therapeutic outcomes of pulmonary embolism (PE) withmanagement of thrombolysis and(or) anticoagulation.
Objectives: To assess value of computed tomography pulmonary angiography(CTPA)in guiding therapeutic decisions and monitoring patients undertaken percutaneous catheter fragment for acute massive pulmonary embolism (PE).
Methods：From Jan2003to Dec2009,35patients were diagnosised as acute massivePE by CTPA (T0) and treated with percutaneous catheter fragmentation. The severitywas assessed by CT obstruction index (Qanadli index) and compared with Millerindex. CTPA, Oxygen saturation(SaO2) and pulmonary artery pressure(PAP) wereperformed as follow-up index.
Results: The mean percentage of Qanadli index was55%±13%(range,40%–75%),Miller index was62%±15%(range,45%–85%). Correlations between them werestatistically significant (r=0.867, p <0.0001). Qanadli index showed significantreduction (T0:55%±13%; T1:12%±10%%;p<0.001) in33patients. Significantcorrelation was observed between Qanadli index and SaO2(r=0.895),PAP(r=0.827).
Conclusion: Qanadli index provides an accurate method to distinguish massive PEfrom sub-massive PE. It can be used to determine therapeutic options and monitorclinical outcomes.
引文
1. European Society of Cardiology. Guidelines on diagnosis and management ofacute pulmonary embolism. Eur Heart J,2000;21:1301-06.
2. Mayo JR, Remy-Jardin M，Muller VT，et al. Pulmonary embolism: prospectivecomparision of spiral CT with ventilation-perfusion scinigraphy. Radiology,1997;205:447-452.
3. Blachere H, Latrabe V, Montaudon M, et al. Pulmonary embolism revealed onhelical CT angiography: comparison with ventilation-perfusion radionuclide lungscanning. AJR,2000;174(4):1041.
4. Remy Jardin M, Remy J, Deschildre F, et al. Diagnosis of pulmonary embolismwith spiral CT: comparison with pulmonary angiography and scintigraphy.Radiology,1996;200:699-706.
5. Kim KI, Muller NL, Mayo JR. Clinically suspected pulmonary embolism: utility ofspiral CT. Radiology,1999;210:693-697.
6. Gefter WB, Hatabu H, Holland GA, et al. Pulmonary thromboembolism: recentdevelopment in diagnosis with CT and MR imaging. Radiology,1995;197:561-574.
7. Nilsson T, Soderberg M,Lundqvist G, et al. A comparison of spiral computedtomography and latex agglutination D-dimer assay in acute pulmonary embolismusing pulmonary arteriography as gold standard. Scand Cardiovasc J,2002;36:373-377.
8. Qanadli SD, Hajjam ME, Mesurolle B, et al. Pulmonary embolism detection:prospective evaluation of dual-section helical CT versus selective pulmonaryarteriography in517patients. Radiology,2000;217:447-455.
9.Galvin JR, Gingrich RD, Hoffman E, et al. Ultrafast computed tomography of thechest. Radiol Clin North Am,1994;32:775
10.Ruiz Y, Caballero P, Caniego JL, et al. Prospective comparison of helical CT withangiography in pulmonary embolism: global and selective vascular territory analysis.Interobserver agreement. Eur Radiol,2003;13:823
11. Schoepf UJ, Holzknecht N, Helmberger TK,et al. Subsegmental pulmonaryemboli: improved detection with thin-collimation multi-detector row spiral CT.Radiology.2002Feb;222(2):483-90.
12.Tillich M, Schoellnast H. Optimized imaging of pulmonary embolism. Eur RadiolSuppl.2005; E66-70.
13. Eyer BA, Goodman LR, Washington L. Clinicians' response to radiologists'reports of isolated subsegmental pulmonary embolism or inconclusive interpretationof pulmonary embolism using MDCT. AJR Am J Roentgenol.2005Feb;184(2):623-8.
14.Cueto SM, Cavanaugh SH,Benenson RS,et al. Computed tomography scan versusventilation-perfusion lung scan in the detection of pulmonary embolism. EmergMed,2001;21:155-164.
15. PIOPED investigators.Value of the ventilation/perfusion scan in acute pulmonaryembolism Results of the prospective investigation of pulmonary embolismdiagnosis(PIOPED). The PIOPED Investigations. JAMA,1990;263:2753-2759.
16. Stein PD, Henry JW, Relyea B. Untreated patients with pulmonary embolism:outcome,clinical and laboratory assessment. Chest,1995;107:931-935.
17. Stassen JM, Lijnen HR, Kieckens L, et al. Small animal thrombosis models forthe evaluation of thrombolytic agents. Circulation.1991Jun;83(6Suppl):IV65-72.
18. Frank H,Weissleder R,Alexei A.Detection of pulmonary emboli by using MRangiography with MPEG-PL-GDDTPA: an experimental study in rabbits.AJR,1994;162:1041.
19. Ovenfors CO, Batra P. Diagnosis of peripheral pulmonary emboli by MR imaging:an experimental study in dogs. Magnetic Resonance Imaging,1988;6:487.
20. Stanford W, Reiners TJ, Thompson BH, et al. Contrast-enhanced thin sliceultrafast computed tomography for the detection of small pulmonary emboli: studiesusing autologous emboli in the pig. Invest Radiol,1994;29:184.
21.余丽娟，张雪林，李任飞，等.家兔急性肺栓塞影像模型的制备[J].中国临床医学影像杂志，2004;15（3）：146-148.
22.Samuel Z Goldhaber. Pulmonary Embolism. Lancet2004;363:1295-305.
23. Katz DS, Loud PA, Bruce D,et al. Combined CT venography and pulmonaryangiography: a comprehensive review. Radiographics.2002;22:S3-19.
24. Pitton MB, Kemmerich G, Herber S,et al. Chronic thromboembolic pulmonaryhypertension: diagnostic impact of Multislice-CT and selective Pulmonary-DSA.Rofo.2002;174(4):474-9.
25. Qanadli SD, Hajjam ME, Mesurolle B, et al. Pulmonary embolism detection:prospective evaluation of dual-section helical CT versus selective pulmonaryarteriography in157patients. Radiology,2000;217:447
26.Garg K, Sieler H, Welsh CH, et al. Clinical validity of helical CT being interpretedas negative for pulmonary embolism: implications for patient treatment. AJR,1999;172(6):1627
1. Wolle TR, Allen TL．Syncope as an emergency department presentation ofpulmonary embolism．Emerg Med,1998;16:27-31
2.王辰．肺栓塞．北京：人民卫生出版社，2003;267-279
3. Ghaye B，Remy J，Remy—Jardin M．Non—traumatic thoracic emergencies：CTdiagnosis of acute pulmonary embolism：the first10years．Eur Radiol,2002;1886—1905．
4. Moser KM． Venous thromboembolism． Am Rev Respir Dis,1990;141:235—249．
5. Dalen JE， Alpert JS． Natural history of pulmonary embolism．Progr CardiovascDiS,1975;17:259—270．
6. Carson JL，Kelley MA，Duff A， et a1．The clinical course of pulmonaryembolism．N Engl J Med,1992;326:1240～1245．
7. Matsumoto AH，Tegtmeyer CJ．Contemporary diagnostic approaches to acutepulmonary emboli．Radiol Clan North Am,1995;33:167—183．
8. Kanne JP, Gotway MB, Thoongsnwan W, et aL. Six cases of acute pulmonaryembolism revealed on unenhanced multi-detector CT of the chest．AJR,2003;180(6):1661-166.
9. Goodman LR，Curtin JJ，Mewissen MW，et a1．Detection of pulmonary embolismin patients with unresolved clinical and scintigraphic diagnosis：helical CT versusangiography．Am J Roentgenol,1995；164:1369一1374．
10. Sostman HD，Layish DT，Tapson FV， et a1．Prospective comparison of helicalCT and MR imaging in clinically suspected acute pulmonary embolism．J MagnResort Imaging,1996;6:275—281．
11. Van Rossum AB，Treurnie FE，Kieft GJ，et a1．Role of spiral volumetric computedtomographic scanning in the assessment of patients with clinical suspicion ofpulmonary embolism and an abnormal ventilation／perfusion1ung scan．Thorax,1996;51:23—28．
12.Van Rossum AB，Pattynama PM，Wjin A，et a1．Pulmonary embolism：validationof spiral CT angiography in149patients．Radiology,1996;201:467—470．
13. Christ Jansen F．Diagnostic imaging of acute pulmonary embolism．Acta Radiol,1997;38(Suppl):1-33．
14. Pruszczyk P，Torbicki A，Pacho R, et al， Noninvasive diagnosis of suspectedsevere pulmonary embolism．Chest,1997;112:722-728．
15. Garg K，Welsh CH，Feyerabend AJ, et a1．Pulmonary embolism：diagnosis withspiral CT and ventilation—perfusion scanning： correlation with pulmonaryangiographic results of Clinical outcome．Radiology,1998;208:20l一208．
16.Herold CJ，Hahne J， Ghaye B, et a1．Prospective evaluation of pulmonaryembolism： diagnostic performance of spiral CT angiography in the ESTIPEPtrial．Radiology,1999;213(Suppl):126—127.
17. Kim KI，Müller NL．Mayo JR．C1inically suspected pulmonary embolism：utilityof spiral CT．Radiology,1999;210:693—697．
18. Blachere H，Latrabe V， Montaudon M， et a1．Pulmonary embolism revealedon helical CT angiography： comparison with ventilation—perfusion radionuclidelung scanning．Am J Roentgenol,2000;174:1041—1047．
19. Qanadli SD, EI Hajjam M，Mesurolle B，et a1．Pulmonary embolism detection：prospective evaluation of dual-section helical CT versus selective pulmonaryarteriography in157patients．Radiology,2000;217:447-455．
20. Remy—Jardin M， Remy J， Baghaie F， et a1． Clinical value of thincollimation in the diagnostic workup of pulmonary embolism．Am J Roentgenol,2000;175:407—411．
21. Van Strijen MJ，De Monye W，Kieft GJ，et a1．Diagnosis of pulmonary embolismwith spiral CT：a prospective cohort study in617consecutive patients．Radiology,1999;213(Suppl):128．
22. Perrier A，Howarth N，Didier D，et a1．Performance of helical computedtomography in unselected outpatients with suspected pulmonary embolism．AnnIntern Med,2001;135:88—97．
23．Quanadli SD，El Hajjam M, Vieillard Baron A, et al. New CT index to quantifyarterial obstruction in pulmonary embolism: comparison with angiographic index andechocardiography. Am J Roentgenol,2001;176:1415–1420
24. Metafratzi ZM，Vassiliou M P，M aglaras GC，et a1．Acute pulmonary embolism：correlation of CT pulmonary artery obstruction index with blood gas values[J]．Am JRoentgenol,2006;186(1):213—219．
25．Remy—Jardin M，Remy J，Artaud D，Deschildre F，Duhamel A. Peripheralpulmonary arteries： optimization of the acquisition protocol．Radiology,1997;204:157—163．
26. Nordstrom M，Lindblad B．Autopsy—verified venous thromboembo1ism withina defined urban population：the city of Malmo，Sweden．APMIS,1998;106:378—384.
27. Goldhaber SZ，Hennekens CH，Evans DA，et a1．Factors associated with correctantemortem diagnosis of major pulmonary embolism．Am J Med,1982;73:822—826．
28. Hoagland PM．Massive pulmonary embolism：pulmonary embolism and deepvein thrombosis．Philadelphia，PA：WB Saunders,1985;79—208．
29. Morgenthaler TI，Ryu JH．Clinical characteristics of fatal pulmonary embolism ina referral hospital．Mayo C1in Proc,1995;70:417—424．
30. Morpurgo M，Rustici A．The clinical picture of pulmonary embolism．Cardiologia,1988;33:1105—1108．
31. Morpurgo M， Schmid C．The spectrum of pulmonary embolism：clinicopathologic correlations．Chest,1995;107(suppl):18S一20S．
32. Remy-Jardin M，Remy J，Wattinne L，et a1．Central pulmonarythromboembolism：diagnosis with spiral volumetric CT with the single-breath-holdtechnique comparison with pulmonary angiography．Radiology,1992;185:381—7.
33.张祥林,吴磊,王倩,等.MSCT阻塞指数与血气分析值的相关关系.中国临床医学影像志,2008;19:790-794.
34. Miller GA，Sutton GC，Kerr lH，et a1．Comparison of streptokinase and heparinin treatment of isolated acute massive pulmonary embolism．Br Med J,1971;2(763):681-684.
35.Walsh PN，Greenspan RH，Simon M．et a1．An angiographic severity index forpulmonary embolism．Circulation,1973;47(suppl II):101-107.
36. Bankier AA，Janata K，Fleischmann D，et a1．Severity assessment of acutepulmonary embolism with spiral CT：evaluation of two modified angiographic scoresand comparison with clinical data．J Thorac Imaging,1997;12(2):150-158.
37. Mastora I，Remy-Jardin M，Masson P，et a1．Severity of acute pulmonaryembolism：evaluation of a new spiral CT angiographic score in correlation withechocardiographic data．Eur Radiol,2003;13(1):29—35．
38. Collomb D，Paramelle PJ，Galaque O et a1．Severity assessment of acutepulmonary embolism：evaluation using helical CT．Eur Radiol,2003;13（7）:1508—1514．
39．陈广，马大庆，贺文,等.多层螺旋CT肺动脉栓塞直接征象与溶栓或（及）抗凝效果的对照.中华放射学杂志,2004;38:1069-1071.
40．周旭辉，李子平，谭国胜.急性大面积肺动脉血栓栓塞症溶栓或（及）抗凝治疗的动CT观察.中华放射学杂志,2005;39:256-261.
1. Wolle TR, Allen TL．Syncope as an emergency department presentation ofpulmonary embolism．Emerg Med,1998;16:27-31
2.王辰．肺栓塞．北京：人民卫生出版社，2003;267-279
3. Ghaye B，Remy J，Remy—Jardin M．Non—traumatic thoracic emergencies：CTdiagnosis of acute pulmonary embolism：the first10years．Eur Radiol,2002;1886—1905．
4. ChaeEJ, SeoJB, JangYM,et al. DualenergyCTforassess ent of theseverity of acutepulmonary embolism: pulmonary perfusion defect score copared with CTangiographic obstruction score and right ventricular/left ventriculardia eterratio. AJRAm J Roentgenol,2010;194(3):604-610
5.弥龙,宋云龙,王东等.双能量CT肺灌注成像评价急性肺栓塞严重程度的可行性研究,解放军医学杂志,2011;36(5):526-529
6.赵殿江,马大庆,贺文,等CT肺血管造影对急性肺栓塞患者右室功能障碍的评价,实用放射学杂志,2008;24(2):168-172
7. Büller HR, Agnelli G, Hull RD. Antithrombotic therapy for venousthromboembolic disease: the Seventh ACCP Conference on Anti-thrombotic andThrombolytic Therapy. Chest,2004;126:401S–28S.
8. Rafique M, Middlemost S, Skoularigis J, Sareli P. Simultaneous mechanical clotfragmentation and pharmacologic thrombolysis in acute massive pulmonaryembolism. Am J Cardiol,1992;69:427-430.
9. Brady AJ, Crake T, Oakley CM. Percutaneous catheter fragmentation of massivepulmonary embolus. Lancet,1992;339:1053-1054.
10. William TK, Michael KG, John DL, Jarrett KR, Daniel YS and Lawrence VH.Catheter-directed Therapy for the Treatment of Massive Pulmonary Embolism:Systematic Review and Meta-analysis of Modern Techniques. J Vasc Interv Radiol,2009;20:1431–1440.
11. William TK, Maurice AAJ, Lawrence VH. Catheter-Directed Embolectomy,Fragmentation, and Thrombolysis for the Treatment of Massive Pulmonary EmbolismAfter Failure of Systemic Thrombolysis. Chest,2008;134;250-254.
12. Zhou WZ, Shi HB, Yang ZQ, Liu S, Zhou CG, Zhao LB, et al. Value ofpercutanous catheter fragmentation in the management of massive pulmonaryembolism. Chin Med J,2009;122(15):1723-1727.
13. Schmitz-Rode T, Janssens U, Schild HH, Bache S, Hanrath P,Gunther RW.Fragmentation of massive pulmonary embolism using a pigtail rotation catheter.Chest,1998;114:1427-1436.
14. Moser KM．Venous thromboembolism． Am Rev Respir Dis,1990；141:235—249．
15. Dalen JE，Alpert JS．Natural history of pulmonary embolism．Progr CardiovascDiS,1975;17:259—270．
16. Carson JL，Kelley MA，Duff A， et a1．The clinical course of pulmonaryembolism．N Engl J Med,1992;326:1240～1245．
17. Matsumoto AH，Tegtmeyer CJ．Contemporary diagnostic approaches to acutepulmonary emboli．Radiol Clan North Am,1995;33:167—183．
18. Kanne JP, Gotway MB, Thoongsnwan W, et aL. Six cases of acute pulmonaryembolism revealed on unenhanced multi-detector CT of the chest．AJR,2003;180(6):1661-1666.
19. Goodman LR，Curtin JJ，Mewissen MW， et a1．Detection of pulmonaryembolism in patients with unresolved clinical and scintigraphic diagnosis：helical CTversus angiography．Am J Roentgenol,1995;164:1369一1374．
20. Sostman HD，Layish DT，Tapson FV， et a1．Prospective comparison of helicalCT and MR imaging in clinically suspected acute pulmonary embolism．J MagnResort Imaging,1996;6:275—281．
21. Van Rossum AB，Treurnie FE，Kieft GJ，et a1．Role of spiral volumetric computedtomographic scanning in the assessment of patients with clinical suspicion ofpulmonary embolism and an abnormal ventilation／perfusion1ung scan．Thorax,1996:51:23—28．
22.Van Rossum AB，Pattynama PM，Wjin A，et a1．Pulmonary embolism：validationof spiral CT angiography in149patients．Radiology,1996;201：467—470．
23. Christ Jansen F．Diagnostic imaging of acute pulmonary embolism．Acta Radiol,1997;38(Suppl):1-33．
24. Ghaye B, Ghuyson, Willems V. Severe pulmonary embolism：pulmonary arteryclot load scores and cardiovascular parameters predictors of mortality. Radiology,2006;239:884-891.
25. Schopf UJ, Costello P. Multidetector-row CT imaging of pulmonary embolism.Semin Roentgenol,2003;38:106.
26. WuAS, Pezzullo JA, Cronan JJ. CT pulmonary angiography: quantification ofpulmonary embolus as a predictor of patient out-come-initial experience. Radiology,2004;230:831-835.
27. Cornelia SP, Mathias Prokop. MDCT for the diagnosis of acute pulmonaryembolism. Eur Radiol Suppl,2005; D21-4.
28. Bankier AA, Janata K, Fleischman D, Kreuser S, Mallek R, Frossard M, et al.Severity assessment of acute pulmonary embolism with spiral CT: evaluation of twomodified angiographic scores and comparison with clinical data. J Thorac Imaging,1997;12:150–158.
29. Quanadli SD, El Hajjam M, Vieillard Baron A, Joseph T, Mesurolle B, Oliva VL,et al. New CT index to quantify arterial obstruction in pulmonary embolism:comparison with angiographic index and echocardiography. Am J Roentgenol,2001;176:1415–1420.
30. Zafiria MM, Miltos PV, George CM, Froso GK, Stauros HC, Afroditi K, et al.Acute Pulmonary Embolism: Correlation of CT Pulmonary Artery Obstruction Indexwith Blood Gas Values. Am J Roentgenol,2006;186:213–219.
31. Cela MC, Amplatz K. Nonsurgical pulmonary embolectomy. In: Cope C, eds.Current techniques in interventional radiology. Philadelphia: Current Medicine,1994;1-12
32. Hyers TM. Venous thromboembolism. Am J Respir Crit Care Med,1999;159:1–14.
33. Goldhaber SZ, Haire WD, Feldstein ML. Alteplase versus heparin in acutepulmonary embolism: randomized trial assessing rightventricular function andpulmonary perfusion. Lancet,1993;341:507–11.
33. Schmitz-Rode T, Janssens U, Schild HH. Fragmentation of massive pulmonaryembolism using a pigtail rotation catheter. Chest,1998;114:1427–1436.
34. Stock KW, Jacob AL, Schnabel KJ. Massive pulmonary embolism: treatment withthrombus fragmentation and local fibrinolysis with recombinant human-tissueplasminogen activator. Cardiovasc Intervent Radiol,1997;20:364–368.
35. Elliott CG. Pulmonary physiology during PE. Chest,1992;101:163s–71s.
36. Wells PS, Anderson DR, Rodger M, et al. Derivation of a simple clinical model tocategorize patients’ probability of pulmonary embolism: increasing the model’s utilitywith the SimpliRED D-dimer. Thromb Haemost,2000;83:416–20.
37.Douma RA, Gibson NS, Gerdes VEA. Validity and clinical utility of the simplifiedWells rule for assessing clinical probability for the exclusion of pulmonary embolism.Thromb Haemost,2009;101:197–200.
38. Miller GA, Sutton GC, Kerr IH, Gibson RV, Honey M. Comparison ofstreptokinase and heparin in treatment of isolated acute massive pulmonary embolism.Br Med J,1971;2:681–4.
39. Kasper W, Meinertz T, Henkel B. Echocardiographic findings in patients withproved pulmonary embolism. Am Heart J,1986;112:1284–90.
40. Ioana M, Martine RJ, Pascal M, Eric G, Valerie D, Jean-Jacques B, et al. Severityof acute pulmonary embolism: evaluation of a new spiral CT angiographic score incorrelation with echocardiographic data. Eur Radiol,2003;13:29–35.
41. Van Rossum AB, Pattynama PMT, Ton ET, Kieft GJ. Spiral CT appearance ofresolving clots at6-week follow-up after acute pulmonary embolism. J Comput AssistTomogr,1998;22:413–417.
42. Remy-Jardin M, Louvegny S, Remy J, Artaud D, Deschildre F, Bauchart JJ et al.Acute central thromboembolic disease: posttherapeutic follow-up with spiral CTangiography. Radiology,1997;203:173–180.
1．Anderson FA Jr,Wheeler HB, Goldberg RJ,et al. A population based perspective ofthe hospital incidence and case fatality rates of deep vein thrombosis and pulmonaryembolism. The Worcester DVT Study. Arch Intern Med,1991;151(5):933-938
2.Remy-Jardin M, Mastora I, Remy J. Pulmonary embolus imaging with multisliceCT. Radiol Clin North Am,2003;41(3):507-519
3.European Society of Cardiology. Guidelines on diagnosis and management of acutepulmonary embolism. Eur Heart J,2000;21:1301-06
4.Mayo JR, Remy-Jardin M，Muller VT，et al. Pulmonary embolism: prospectivecomparision of spiral CT with ventilation-perfusion scinigraphy. Radiology,1997;205:447-452.
5.Schibany N, Fleischmann D, Thallinger C,et al. Equiment availability anddiagnostic strategies for suspected pulmonary embolism in Austria.EurRadiol,2001;11:2287-2294
6．Ruiz Y, Caballero P, Caniego JL, et al. Prospective comparison of helical CT withangiography in pulmonary embolism: global and selective vascular territory analysis.Interobserver agreement. Eur Radiol,2003;13(4):823-9.
7.PIOPED investigators. Value of the ventilation/perfusion scan in acute pulmonaryembolism.JAMA,1990;263:2753.
8．Blachere H, Latrabe V, Montaudon M,et al. Pulmonary embolism revealed onhelical CT angiography:comparison with ventilation-perfusion radionuclide lungscanning. AJR,2000;174:1041-1047.
9．Reittner P, Coxson HO, Nakano Y, et al. Pulmonary embolism: comparison ofgadolinium-enhanced MR angiography with contrast-enhanced spiral CT in a porcinemodel. Acad Radiol,2001;8:343-350.
10.Bova C, Greco F, Misuraca G, et al. Diagnosis utility of echocardiography inpatients with suspected pulmonary embolism.AmJ Emerg Med,2003;21:180-183
11.Mayo JR, Remy Jardin M, Muller NL, et al. Pulmonary embolism: prospectivecomparision of spiral CT with ventilation/perfusionscintigraphy.Radiology,1997;205:447-452.
12．Herzog P, Wildberger JE, Niethammer M, et al.CT perfusion imaging of the lungin pulmonary embolism. Acad Radiol,2003;10:1132-1146.
13.Fleischmann D, Use of high concentration contrast media: principles andrationale-vascular district. Eur Radiol,2003;45(suppl1):S88-93.
14.Garg K, Macey L, Helical CT scanning in the diagnosis of pulmonary embolism.Respiration,2003;70:231-237.
15.Perrier A, Nendaz MR, Sarasin FP,et al.Cost-effectiveness analysis of diagnosticstraregies for suspected pulmonary embolism including helical computed tomography.Am J Respirat Crit Care Med,2003;167:39-44.
16.Galvin JR, Gingrich RD, Hoffman E, et al. Ultrafast computed tomography of thechest. Radiol Clin North Am,1994;32:775.
17.Ruiz Y, Caballero P, Caniego JL, et al. Prospective comparison of helical CT withangiography in pulmonary embolism: global and selective vascular territory analysis.Interobserver agreement. Eur Radiol,2003;13:823.
18.Qanadli SD, Hajjam ME, Mesurolle B, et al. Pulmonary embolism detection:prospective evaluation of dual-section helical CT versus selective pulmonaryarteriography in157patients. Radiology,2000;217:447
19.Ghaye B, Szapiro D, Mastora I, et al. Peripheral pulmonary arteries: how far in thelung does multi-detector row spiral CT allow analysis? Radiology,2001;219:629.
20.Schoepf UJ, Kessler MA, Rieger CT,et al. Multislice CT imaginging of pulmonaryembolism. EurRadiol,2001;11:2278-2286.
21.Kruip MJ, Slob MJ, Buller HR, et al. A prospective clinical study on the feasibilityand safety of a combined noninvasive/pulmonary angiography strategy in patientswith suspected pulmonary embolism:an interim analysis. ClinAppl Thromb Hemost,1999;5:222-225.
22.Gulsun M, Goodman LR, Washington L. Venous thromboembolic disease: wheredoes multidetector computed tomography fit? Cardiol in,2003;21:631-638.
23.王辰，主编，肺栓塞，北京，人民卫生出版社，2003;263-279.
24.Reid JH, Murchison JT. Acute right ventricular dilation: a new helical CT sign ofmassive pulmonary embolism. Clin Radiol,1998;53:694-698
25.周旭辉，李菁，李子平等。急性肺动脉栓塞的CT表现与疾病严重程度的关系。中华放射击学杂志，2006;40（9）:918-922。
26.Ghuysen A, Ghaye B, Willems V, et al. Computed tomographic pulmonaryangiography and prognostic significance in patients with acute pulmonary embolism.Thorax,2005Nov;60(11):956-961.
27.Van der Meer RW, Pattynama PM, van Strijen MJ, et al. Right ventriculardysfunction and pulmonary obstruction index at helical CT: prediction of clinicaloutcome during3-month follow-up in patients with acute pulmonary embolism.Radiology.2005Jun;235(3):798-803.
28.Samuel Z Goldhaber. Pulmonary Embolism. Lancet,2004;363:1295-305.
29.Kavangh EC, O’Hare A, Hargaden G, et al. Risk of pulmonary embolism afternegative MDCT pulmonary angiography findings. AJR,2004;182:499-504.
30.RemyJM, Tillie LI, Szapiro D, et al. CTangiography of pulmonary embolism inpatients with underlying respiratory disease:impact of multislice CT on image qualityand negative predictive value. Eur Radoil,2002;12:1971-1978
31.Tillie LI, Mastora I,Radenne F, et al. Risk of pulmonary embolism after a negativespiral CT angiogram in patients with pulmonary disease:1year clinical follow-upstudy. Radiology,2002;223:461-467.
32.Kruip MJ, Leclercq MG, Van Der Heul C, et al. Diagnostic strategies for excludingpulmonary embolism in clinical outcome studies,a systematic review. Ann Intern Med,2003;138:941-951.
33.Greco F, Zanolini A, Bova C, et al. combined diagnostic approach to venousthromboembolism with multidetector computed tomography. Ital Heart J,2003;4:226-231.
34.Wildberger JE, Niethammer MU, Klotz E, et al, Multi-Slice CT for Visualizationof Pulmonary embolism Using Perfusion Weighted Color Maps. Fortschr Rntgenstr,2001;173(9):289-294.
35.Wildberger JE, Klotz E, Ditt H, et al. Multislice computed tomography perfusionimaging for visualization of acute pulmonary embolism: animal experience. EurRadiol,2005;15(7):1378-1386.
36.Thieme SF, Ashoori N, Bamberg F, et al. Severity assessment of pulmonaryembolism using dual energy CT-correlation of a pulmonary perfusion defect scorewith clinical and morphological parameters of blood oxygenation and rightventricular failure. Eur Radiol,2012Feb;22(2):269-278
37.Hoey ET, Mirsadraee S, Pepke-Zaba J, et al. Dual-energy CT angiography forassessment of regional pulmonary perfusion in patients with chronic thromboembolicpulmonary hypertension: initial experience,2011Mar;196(3):524-532
38. Bauer RW, Kerl JM, Weber E, et al. Lung perfusion analysis with dual energy CTin patients with suspected pulmonary embolism--influence of window settings on thediagnosis of underlying pathologies of perfusion defects. Eur J Radiol,2011Dec;80(3):e476-482
39.Shahir K, Goodman LR, Tali A, et al. Pulmonary embolism in pregnancy: CTpulmonary angiography versus perfusion scanning. AJR Am J Roentgenol,2010;195(3):W214-220
40.Cham MD, Yankelevitz DF, Henschke CL, et al. Indirect venography: consistentdetection of DVT in suspected pulmonary embolism.RSNA,2002;151:174
41.Kevin M, Duwe MS, Nancy E,et al. Evaluation of the lower extremity veins inpatients with suspected pulmonary embolism. AJR,2000;175:1525-1531.
42. Katz DS, Loud PA, Bruce D,et al, Combined CT venography and pulmonaryangiography: a comprehensive review. Radiographics,2002Oct;22Spec No:S3-19
43. Wildberger JE, Klotz E, Ditt H, et al. Multi-slice CT for visualization of acutepulmonary embolism: single breath-hold subtraction technique. Rofo,2005;177(1):17-23.
44.Chiang EE, Boiselle PM, Raptopoulos V, et al. Detection of pulmonary embolism:comparison of paddlewheel and coronal CT reformation-Initialexperience. Radiology,2003;228(2):577-582.
45.吴春根,周康荣,汤敏.心电标记回顾性肺动脉多层螺旋CT血管造影术(附5例肺动脉栓塞).临床放射学杂志,2003;22:287
46.Patel S, Kazerooni EA, Cascade PN, et al. Pulmonary embolism: optimization ofsmall pulmonary artery visualization at multi-detector row CT. Radiology,2003;227(2):455-60.
47.Schoepf UJ, Costello P. Spiral computed tomography is the first-line chestimaging test for acute pulmonary embolism:yes.J Thromb Haemost,2005;3:7-10.
48.Hartmann IJ, Wittenberg R, Schaefer-Prokop C. Imaging of acute pulmonaryembolism using multi-detector CT angiography: An update on imaging technique andinterpretation,2010Mar11.[Epub ahead of print]
49.Todoran TM, Sobieszczyk P. Catheter-based therapies for massive pulmonaryembolism,2010Mar-Apr;52(5):429-437.
50. Porres-Aguilar M, Munoz OC, Alvarez P, et al. Successful percutaneousmechanical thrombectomy in a haemodynamically unstable patient with massivepulmonary embolism,2010Feb7.[Epub ahead of print]
51. Bazeed MF, Saad A, Sultan A,et al. Prediction of pulmonary embolism outcomeand severity by computed tomography. Acta Radiol,2010Apr;51(3):271-276.
52. Stein P D, Fowler S E, Goodman L R, et al. Multidetector computed tomographyfor acute pulmonary embolism. N Engl J Med,2006;35:2317-232
1. Ghaye B，Remy J，Remy—Jardin M．Non—traumatic thoracic emergencies：CTdiagnosis of acute pulmonary embolism：the first10years．Eur Radiol,2002;1886—1905．
2. Moser KM． Venous thromboembolism． Am Rev Respir Dis,1990;141:235—249．
3. Dalen JE， Alpert JS． Natural history of pulmonary embolism．Progr CardiovascDiS,1975;17:259—270．
4. Carson JL，Kelley MA，Duff A， et a1．The clinical course of pulmonaryembolism．N Engl J Med,1992;326:1240-1245．
5. Matsumoto AH，Tegtmeyer CJ．Contemporary diagnostic approaches to acutepulmonary emboli．Radiol Clan North Am,1995;33:167-183．
6. Urokinase Pulmonary Embolism Trial．A National Cooperative Study．Circulation,1973;47(Suppl2):1-108．
7. Gervifl AS．Complications of heparin therapy．Surg Gynecol Obstet,1975;140:789-796．
8. Kashtan J， Conti S， Blaisdell FW． Heparin therapy for deep venousthrombosis．Am J Surg,1980;140:836-840．
9. Cheely R，McCartney wH，Perry JR，et a1．The role of noninvasive tests versuspulmonary angiography in the diagnosis of pulmonary embolism．Am J Med,1981;70:17-22．
10. Fihn SD，McDonell M，Martin D，et a1．Risk factors for complications of chronicancoagulation．A multicenter study．Warfarin optimized outpatient follow—up studygroup．Ann Intern Med,1993;18:511-520．
11. Landefeld CS， Beyth RJ． Anticoagulant—related bleeding： clinicalepidemiology，prediction and prevention．Am J Med,1993;95:315-328．
12.Blachere H， Latrabe V， Montaudon M， et al．Pulmonary embolism revealedon helicalCT angiography：comparison with ventilation-perfusion radionuclide lungscanning[J]. Am J Roentgenol,2000;174(4):1041-1047.
13. Ghaye B, Szapiro D, Mastora I, et al. Peripheral pulmonary arteries: how far inthe lung does multi-detector row spiral CT allow analysis. Radiology,2001;219(3):629.
14. Patel S, Kazerooni E, Cascade P. Pulmonary embolism: optimization of smallpulmonary artery visualization at multi-detector row CT. Radiology,2003;227(2):455.
15. Jones Stephen E, Jones, Wittram Conrad, et al. The inderterminate CT pulmonaryavgiogram: imaging characteristics and patient clinical outcome. Radiology,2005;237:329-337.
16. Blachere H, Latrabe V, Montaudon M, et al. Pulmonary embolism revealed onhelical CT angiography: comparison with ventilation-perfusion radionuclide lungscanning. AJR,2000;174:1041-1047.
17. Schoellnast Helmut, Defutschmann Hnnes A, Fritz Gerald, et al. MDCTangiography of the pulmonary arteries: influence of iodine flow concentration onvessel attenuation and visualization. AJR,2005;84:1935-1939.
18. Patel S，Kazerooni EA，Cascade PN．Pulmonary embolism：optimization of smallpulmonary artery visualization at multi-detector row CT．Radiology,2003;227(2):455-460．
19. Schoepf UJ，Holzknecht N，Helmberger TK，et al. Sub-segmental pulmonaryemboli： improved detection with thin-collimation multi-detector row spiralCT．Radiology,2002;222(2):483-490．
20. Kanne JP, Gotway MB, Thoongsnwan W, et aL. Six cases of acute pulmonaryembolism revealed on unenhanced multi-detector CT of the chest[J]．AJR,2003;180(6):1661-1666.
21. Goodman LR，Curtin JJ，Mewissen MW， et a1．Detection of pulmonaryembolism in patients with unresolved clinical and scintigraphic diagnosis：helical CTversus angiography．Am J Roentgenol,1995;164:1369-1374．
22. Sostman HD，Layish DT，Tapson FV， et a1．Prospective comparison of helicalCT and MR imaging in clinically suspected acute pulmonary embolism．J MagnResort Imaging,1996;6:275-281．
23. Van Rossum AB，Treurnie FE，Kieft GJ，et a1．Role of spiral volumetric computedtomographic scanning in the assessment of patients with clinical suspicion ofpulmonary embolism and an abnormal ventilation/perfusion1ung scan．Thorax,1996;51:23-28．
24.Van Rossum AB，Pattynama PM，Wjin A，et a1．Pulmonary embolism：validationof spiral CT angiography in149patients．Radiology1996：201：467—470．ChristJansen F．Diagnostic imaging of acute pulmonary embolism．Acta Radiol,1997;38(Suppl):1-33．
25. Christ Jansen F．Diagnostic imaging of acute pulmonary embolism．Acta Radiol,1997;38(Suppl):1-33．
26. Pruszczyk P，Torbicki A，Pacho R, et al， Noninvasive diagnosis of suspectedsevere pulmonary embolism．Chest,1997;112:722-728．
27. Garg K，Welsh CH，Feyerabend AJ, et a1．Pulmonary embolism：diagnosis withspiral CT and ventilation—perfusion scanning： correlation with pulmonaryangiographic results of Clinical outcome．Radiology,1998;208:20l-208．
28.Herold CJ，Hahne J， Ghaye B, et a1．Prospective evaluation of pulmonaryembolism： diagnostic performance of spiral CT angiography in the ESTIPEPtrial．Radiology,1999;213(Suppl):126-127.
29. Kim KI，Müller NL．Mayo JR．C1inically suspected pulmonary embolism：utilityof spiral CT．Radiology,1999;210:693-697．
30. Blachere H，Latrabe V， Montaudon M， et a1．Pulmonary embolism revealedon helical CT angiography： comparison with ventilation—perfusion radionuclidelung scanning．Am J Roentgenol,2000;174:1041-1047．
31. Qanadli SD, EI Hajjam M，Mesurolle B，et a1．Pulmonary embolism detection：prospective evaluation of dual-section helical CT versus selective pulmonaryarteriography in157patients．Radiology,2000;217:447-455．
32. Remy—Jardin M， Remy J， Baghaie F， et a1． Clinical value of thincollimation in the diagnostic workup of pulmonary embolism．Am J Roentgenol,2000;175:407-411．
33. Van Strijen．MJ, De Monye W，Kieft GJ，et a1．Diagnosis of pulmonary embolismwith spiral CT：a prospective cohort study in617consecutive patients．Radiology,1999;213(Suppl):128．
34. Perrier A，Howarth N，Didier D，et a1．Performance of helical computedtomography in unselected outpatients with suspected pulmonary embolism．AnnIntern Med,2001;135:88-97．
35. Kauczor HU，Heussel CP，Thelen M．Update on diagnostic strategies ofpulmonary embolism．Eur Radiol,1999;9:262-275．
36. Miller GA，Sutton GC，Kerr lH，et a1．Comparison of streptokinase and heparinin treatment of isolated acute massive pulmonary embolism．Br Med J,1971;2(763):681-684.
37.Walsh PN，Greenspan RH，Simon M．et a1．An angiographic severity index forpulmonary embolism[J]．Circulation,1973,47(suppl II):101-107.
38. Bankier AA，Janata K，Fleischmann D，et a1．Severity assessment of acutepulmonary embolism with spiral CT：evaluation of two modified angiographic scoresand comparison with clinical data[J]．J Thorac Imaging,1997;12(2):150-158.
39. Qanadli SD，El Hjjam M，Vieillard—Baron A，et a1．New CT index to quantifyarterial obstruction in pulmonary embolism：comparison with angiographic index andechocardiography[J]．Am J Roentgenol,2001;176(6):1415-1420．
40. Mastora I，Remy-Jardin M，Masson P，et a1．Severity of acute pulmonaryembolism：evaluation of a new spiral CT angiographic score in correlation withechocardiographic data[J]．Eur Radiol,2003;13(1):29-35．
41. Collomb D，Paramelle PJ，Galaque O et a1．Severity assessment of acutepulmonary embolism：evaluation using helical CT．Eur Radiol,2003;13（7）:1508-1514．
42. Metafratzi ZM，Vassiliou M P，M aglaras GC，et a1．Acute pulmonary embolism：correlation of CT pulmonary artery obstruction index with blood gas values．Am JRoentgenol,2006;186(1):213-219．
43.张辉，邹利光，逢鑫等，多层螺旋CT血管造影对肺动脉栓塞诊断和疾病严重程度的评价价值，第三军医大学学报，2009;31（21）:2053-2056.
44.Lualdi JC, Goldhaber SZ. Right ventricular dysfunction after acute pulmonaryembolism: pathophysiologic factors, detection, and therapeutic implications. AmHeart J,1995;130:1276–1282.
45.Kasper W, Meinertz T, Henkel B, et al. Echocardiographic findings in patientswith proved pulmonary embolism. Am Heart J,1986;112:1284–1290.
46.Cela MC， Amplatz K．Nonsurgical pulmonary embolectomy ［M］//Cope C,ed．Current Techniques in Interventional Radiology．Philadelphia：Current Medicine,1994;1-12．
47.Dalen JE， Alpert JS． Natural history of pulmonary embolism．Prog CardiovascDis,1975;17:259-270．
48. Hartmann IJ, Wittenberg R, Schaefer-Prokop C. Imaging of acute pulmonaryembolism using multi-detector CT angiography: An update on imaging technique andinterpretation. Eur J Radiol,2010; Mar11.[Epub ahead of print]
49. Todoran TM, Sobieszczyk P. Catheter-based therapies for massive pulmonaryembolism,2010Mar-Apr;52(5):429-437.
50. Porres-Aguilar M, Munoz OC, Alvarez P, et al. Successful percutaneousmechanical thrombectomy in a haemodynamically unstable patient with massivepulmonary embolism. Respirology,2010Feb7.[Epub ahead of print]
51. Bazeed MF, Saad A, Sultan A,et al. Prediction of pulmonary embolism outcomeand severity by computed tomography. Acta Radiol,2010Apr;51(3):271-276.
52.王庆庆，施海彬，周卫忠，等。单纯经皮机械祛栓治疗急性大面积肺栓塞的临床应用。介入放射学杂志,2010;19（4）:291-295
53. William TK, Michael KG, John DL, Jarrett KR, Daniel YS and Lawrence VH.Catheter-directed Therapy for the Treatment of Massive Pulmonary Embolism:Systematic Review and Meta-analysis of Modern Techniques. J Vasc Interv Radiol,2009;20:1431–1440.
54. William TK, Maurice AAJ, Lawrence VH. Catheter-Directed Embolectomy,Fragmentation, and Thrombolysis for the Treatment of Massive Pulmonary EmbolismAfter Failure of Systemic Thrombolysis. Chest,2008;134:250-254.
55. Zhou WZ, Shi HB, Yang ZQ, Liu S, Zhou CG, Zhao LB, et al. Value ofpercutanous catheter fragmentation in the management of massive pulmonaryembolism. Chin Med J,2009;122(15):1723-1727.
56. Rafique M, Middlemost S, Skoularigis J, Sareli P. Simultaneous mechanical clotfragmentation and pharmacologic thrombolysis in acute massive pulmonaryembolism. Am J Cardiol,1992;69:427-430.
57. Brady AJ, Crake T, Oakley CM. Percutaneous catheter fragmentation of massivepulmonary embolus. Lancet,1992;339:1053-1054.
58. Schmitz-Rode T, Janssens U, Schild HH, Bache S, Hanrath P,Gunther RW.Fragmentation of massive pulmonary embolism using a pigtail rotation catheter.Chest,1998;114:1427-1436.
59.张学彬，吕维富，孙一兵，等．经皮介入碎栓及溶栓治疗大面积肺栓塞，介入放射学杂志，2005；14：39-42．
60. Goldhaber SZ． Percutaneous mechanical thrombectomy for massivepulmonary embolism improve safety and efficacy by sharinginformation． Catheter Cardiovasc Interv,2007;70:807-808．
61.弥龙,宋云龙,王东等.双能量CT肺灌注成像评价急性肺栓塞严重程度的可行性研究,解放军医学杂志,2011;36(5):526-529
62.吴京兰,谭四平,沈比先等.双源CT双能量肺灌注成像技术诊断急性肺动脉栓塞的临床应用.临床心血管病杂志,2011;27(5):385-388
63. Clough A V, Hawort S T, Roerig D L, et al. Influenceof gravity onradiographiccontrast mate rial based measurement of regional blood flowdistribution. Acad Radiol,2003;10:128-138.
64. Stein P D, Fowler S E, Goodman L R, et al. Multidetector computed tomographyfor acute pulmonary embolism. N Engl J Med,2006;35:2317-2327
65. Pontana F, Faiver J B, Remyjardin M, et al. Lung perfusion with dual energymultidetector row CT (MDCT): feasibility for the evaluation of acute pulmonaryembolism in117consecutive patients. Acad Radiol,2008;15:19–150
66. Wildberger J E, Niethammer M U, Klota Z E, et al. Multislice CT forvisualization of pulmonary embolism using perfusion weighted color map. Rofo,2001;173:289-293
67. Thieme S F, Becker C R, Hacker M, et al. Dual energy CT for the assessment oflung perfusion correlation to scintigraphy. Eur J Radiol,2008;68:3692-3741
68. Thieme SF, Ashoori N, Bamberg F, et al. Severity assessment of pulmonaryembolism using dual energy CT-correlation of a pulmonary perfusion defect scorewith clinical and morphological parameters of blood oxygenation and rightventricular failure. Eur Radiol,2012Feb;22(2):269-78
69. Hoey ET, Mirsadraee S, Pepke-Zaba J, et al. Dual-energy CT angiography forassessment of regional pulmonary perfusion in patients with chronic thromboembolicpulmonary hypertension: initial experience. AJR Am J Roentgenol,2011Mar;196(3):524-532
70. Bauer RW, Kerl JM, Weber E, et al. Lung perfusion analysis with dual energy CTin patients with suspected pulmonary embolism--influence of window settings on thediagnosis of underlying pathologies of perfusion defects. Eur J Radiol,2011Dec;80(3):e476-482
71. Shahir K, Goodman LR, Tali A, et al. Pulmonary embolism in pregnancy: CTpulmonary angiography versus perfusion scanning. AJR Am J Roentgenol,2010;195(3): W214-220
72. Chae EJ, Seo JB, Jang YM, et al. Dual-energy CT for assessment of the severityof acute pulmonary embolism: pulmonary perfusion defect score compared with CTangiographic obstruction score and right ventricular/left ventricular diameter ratio.AJR Am J Roentgenol,2010;194(3):604-610
2. Mayo JR, Remy-Jardin M，Muller VT，et al. Pulmonary embolism: prospectivecomparision of spiral CT with ventilation-perfusion scinigraphy. Radiology,1997;205:447-452.
3. Blachere H, Latrabe V, Montaudon M, et al. Pulmonary embolism revealed onhelical CT angiography: comparison with ventilation-perfusion radionuclide lungscanning. AJR,2000;174(4):1041.
4. Remy Jardin M, Remy J, Deschildre F, et al. Diagnosis of pulmonary embolismwith spiral CT: comparison with pulmonary angiography and scintigraphy.Radiology,1996;200:699-706.
5. Kim KI, Muller NL, Mayo JR. Clinically suspected pulmonary embolism: utility ofspiral CT. Radiology,1999;210:693-697.
6. Gefter WB, Hatabu H, Holland GA, et al. Pulmonary thromboembolism: recentdevelopment in diagnosis with CT and MR imaging. Radiology,1995;197:561-574.
7. Nilsson T, Soderberg M,Lundqvist G, et al. A comparison of spiral computedtomography and latex agglutination D-dimer assay in acute pulmonary embolismusing pulmonary arteriography as gold standard. Scand Cardiovasc J,2002;36:373-377.
8. Qanadli SD, Hajjam ME, Mesurolle B, et al. Pulmonary embolism detection:prospective evaluation of dual-section helical CT versus selective pulmonaryarteriography in517patients. Radiology,2000;217:447-455.
9.Galvin JR, Gingrich RD, Hoffman E, et al. Ultrafast computed tomography of thechest. Radiol Clin North Am,1994;32:775
10.Ruiz Y, Caballero P, Caniego JL, et al. Prospective comparison of helical CT withangiography in pulmonary embolism: global and selective vascular territory analysis.Interobserver agreement. Eur Radiol,2003;13:823
11. Schoepf UJ, Holzknecht N, Helmberger TK,et al. Subsegmental pulmonaryemboli: improved detection with thin-collimation multi-detector row spiral CT.Radiology.2002Feb;222(2):483-90.
12.Tillich M, Schoellnast H. Optimized imaging of pulmonary embolism. Eur RadiolSuppl.2005; E66-70.
13. Eyer BA, Goodman LR, Washington L. Clinicians' response to radiologists'reports of isolated subsegmental pulmonary embolism or inconclusive interpretationof pulmonary embolism using MDCT. AJR Am J Roentgenol.2005Feb;184(2):623-8.
14.Cueto SM, Cavanaugh SH,Benenson RS,et al. Computed tomography scan versusventilation-perfusion lung scan in the detection of pulmonary embolism. EmergMed,2001;21:155-164.
15. PIOPED investigators.Value of the ventilation/perfusion scan in acute pulmonaryembolism Results of the prospective investigation of pulmonary embolismdiagnosis(PIOPED). The PIOPED Investigations. JAMA,1990;263:2753-2759.
16. Stein PD, Henry JW, Relyea B. Untreated patients with pulmonary embolism:outcome,clinical and laboratory assessment. Chest,1995;107:931-935.
17. Stassen JM, Lijnen HR, Kieckens L, et al. Small animal thrombosis models forthe evaluation of thrombolytic agents. Circulation.1991Jun;83(6Suppl):IV65-72.
18. Frank H,Weissleder R,Alexei A.Detection of pulmonary emboli by using MRangiography with MPEG-PL-GDDTPA: an experimental study in rabbits.AJR,1994;162:1041.
19. Ovenfors CO, Batra P. Diagnosis of peripheral pulmonary emboli by MR imaging:an experimental study in dogs. Magnetic Resonance Imaging,1988;6:487.
20. Stanford W, Reiners TJ, Thompson BH, et al. Contrast-enhanced thin sliceultrafast computed tomography for the detection of small pulmonary emboli: studiesusing autologous emboli in the pig. Invest Radiol,1994;29:184.
21.余丽娟，张雪林，李任飞，等.家兔急性肺栓塞影像模型的制备[J].中国临床医学影像杂志，2004;15（3）：146-148.
22.Samuel Z Goldhaber. Pulmonary Embolism. Lancet2004;363:1295-305.
23. Katz DS, Loud PA, Bruce D,et al. Combined CT venography and pulmonaryangiography: a comprehensive review. Radiographics.2002;22:S3-19.
24. Pitton MB, Kemmerich G, Herber S,et al. Chronic thromboembolic pulmonaryhypertension: diagnostic impact of Multislice-CT and selective Pulmonary-DSA.Rofo.2002;174(4):474-9.
25. Qanadli SD, Hajjam ME, Mesurolle B, et al. Pulmonary embolism detection:prospective evaluation of dual-section helical CT versus selective pulmonaryarteriography in157patients. Radiology,2000;217:447
26.Garg K, Sieler H, Welsh CH, et al. Clinical validity of helical CT being interpretedas negative for pulmonary embolism: implications for patient treatment. AJR,1999;172(6):1627
1. Wolle TR, Allen TL．Syncope as an emergency department presentation ofpulmonary embolism．Emerg Med,1998;16:27-31
2.王辰．肺栓塞．北京：人民卫生出版社，2003;267-279
3. Ghaye B，Remy J，Remy—Jardin M．Non—traumatic thoracic emergencies：CTdiagnosis of acute pulmonary embolism：the first10years．Eur Radiol,2002;1886—1905．
4. Moser KM． Venous thromboembolism． Am Rev Respir Dis,1990;141:235—249．
5. Dalen JE， Alpert JS． Natural history of pulmonary embolism．Progr CardiovascDiS,1975;17:259—270．
6. Carson JL，Kelley MA，Duff A， et a1．The clinical course of pulmonaryembolism．N Engl J Med,1992;326:1240～1245．
7. Matsumoto AH，Tegtmeyer CJ．Contemporary diagnostic approaches to acutepulmonary emboli．Radiol Clan North Am,1995;33:167—183．
8. Kanne JP, Gotway MB, Thoongsnwan W, et aL. Six cases of acute pulmonaryembolism revealed on unenhanced multi-detector CT of the chest．AJR,2003;180(6):1661-166.
9. Goodman LR，Curtin JJ，Mewissen MW，et a1．Detection of pulmonary embolismin patients with unresolved clinical and scintigraphic diagnosis：helical CT versusangiography．Am J Roentgenol,1995；164:1369一1374．
10. Sostman HD，Layish DT，Tapson FV， et a1．Prospective comparison of helicalCT and MR imaging in clinically suspected acute pulmonary embolism．J MagnResort Imaging,1996;6:275—281．
11. Van Rossum AB，Treurnie FE，Kieft GJ，et a1．Role of spiral volumetric computedtomographic scanning in the assessment of patients with clinical suspicion ofpulmonary embolism and an abnormal ventilation／perfusion1ung scan．Thorax,1996;51:23—28．
12.Van Rossum AB，Pattynama PM，Wjin A，et a1．Pulmonary embolism：validationof spiral CT angiography in149patients．Radiology,1996;201:467—470．
13. Christ Jansen F．Diagnostic imaging of acute pulmonary embolism．Acta Radiol,1997;38(Suppl):1-33．
14. Pruszczyk P，Torbicki A，Pacho R, et al， Noninvasive diagnosis of suspectedsevere pulmonary embolism．Chest,1997;112:722-728．
15. Garg K，Welsh CH，Feyerabend AJ, et a1．Pulmonary embolism：diagnosis withspiral CT and ventilation—perfusion scanning： correlation with pulmonaryangiographic results of Clinical outcome．Radiology,1998;208:20l一208．
16.Herold CJ，Hahne J， Ghaye B, et a1．Prospective evaluation of pulmonaryembolism： diagnostic performance of spiral CT angiography in the ESTIPEPtrial．Radiology,1999;213(Suppl):126—127.
17. Kim KI，Müller NL．Mayo JR．C1inically suspected pulmonary embolism：utilityof spiral CT．Radiology,1999;210:693—697．
18. Blachere H，Latrabe V， Montaudon M， et a1．Pulmonary embolism revealedon helical CT angiography： comparison with ventilation—perfusion radionuclidelung scanning．Am J Roentgenol,2000;174:1041—1047．
19. Qanadli SD, EI Hajjam M，Mesurolle B，et a1．Pulmonary embolism detection：prospective evaluation of dual-section helical CT versus selective pulmonaryarteriography in157patients．Radiology,2000;217:447-455．
20. Remy—Jardin M， Remy J， Baghaie F， et a1． Clinical value of thincollimation in the diagnostic workup of pulmonary embolism．Am J Roentgenol,2000;175:407—411．
21. Van Strijen MJ，De Monye W，Kieft GJ，et a1．Diagnosis of pulmonary embolismwith spiral CT：a prospective cohort study in617consecutive patients．Radiology,1999;213(Suppl):128．
22. Perrier A，Howarth N，Didier D，et a1．Performance of helical computedtomography in unselected outpatients with suspected pulmonary embolism．AnnIntern Med,2001;135:88—97．
23．Quanadli SD，El Hajjam M, Vieillard Baron A, et al. New CT index to quantifyarterial obstruction in pulmonary embolism: comparison with angiographic index andechocardiography. Am J Roentgenol,2001;176:1415–1420
24. Metafratzi ZM，Vassiliou M P，M aglaras GC，et a1．Acute pulmonary embolism：correlation of CT pulmonary artery obstruction index with blood gas values[J]．Am JRoentgenol,2006;186(1):213—219．
25．Remy—Jardin M，Remy J，Artaud D，Deschildre F，Duhamel A. Peripheralpulmonary arteries： optimization of the acquisition protocol．Radiology,1997;204:157—163．
26. Nordstrom M，Lindblad B．Autopsy—verified venous thromboembo1ism withina defined urban population：the city of Malmo，Sweden．APMIS,1998;106:378—384.
27. Goldhaber SZ，Hennekens CH，Evans DA，et a1．Factors associated with correctantemortem diagnosis of major pulmonary embolism．Am J Med,1982;73:822—826．
28. Hoagland PM．Massive pulmonary embolism：pulmonary embolism and deepvein thrombosis．Philadelphia，PA：WB Saunders,1985;79—208．
29. Morgenthaler TI，Ryu JH．Clinical characteristics of fatal pulmonary embolism ina referral hospital．Mayo C1in Proc,1995;70:417—424．
30. Morpurgo M，Rustici A．The clinical picture of pulmonary embolism．Cardiologia,1988;33:1105—1108．
31. Morpurgo M， Schmid C．The spectrum of pulmonary embolism：clinicopathologic correlations．Chest,1995;107(suppl):18S一20S．
32. Remy-Jardin M，Remy J，Wattinne L，et a1．Central pulmonarythromboembolism：diagnosis with spiral volumetric CT with the single-breath-holdtechnique comparison with pulmonary angiography．Radiology,1992;185:381—7.
33.张祥林,吴磊,王倩,等.MSCT阻塞指数与血气分析值的相关关系.中国临床医学影像志,2008;19:790-794.
34. Miller GA，Sutton GC，Kerr lH，et a1．Comparison of streptokinase and heparinin treatment of isolated acute massive pulmonary embolism．Br Med J,1971;2(763):681-684.
35.Walsh PN，Greenspan RH，Simon M．et a1．An angiographic severity index forpulmonary embolism．Circulation,1973;47(suppl II):101-107.
36. Bankier AA，Janata K，Fleischmann D，et a1．Severity assessment of acutepulmonary embolism with spiral CT：evaluation of two modified angiographic scoresand comparison with clinical data．J Thorac Imaging,1997;12(2):150-158.
37. Mastora I，Remy-Jardin M，Masson P，et a1．Severity of acute pulmonaryembolism：evaluation of a new spiral CT angiographic score in correlation withechocardiographic data．Eur Radiol,2003;13(1):29—35．
38. Collomb D，Paramelle PJ，Galaque O et a1．Severity assessment of acutepulmonary embolism：evaluation using helical CT．Eur Radiol,2003;13（7）:1508—1514．
39．陈广，马大庆，贺文,等.多层螺旋CT肺动脉栓塞直接征象与溶栓或（及）抗凝效果的对照.中华放射学杂志,2004;38:1069-1071.
40．周旭辉，李子平，谭国胜.急性大面积肺动脉血栓栓塞症溶栓或（及）抗凝治疗的动CT观察.中华放射学杂志,2005;39:256-261.
1. Wolle TR, Allen TL．Syncope as an emergency department presentation ofpulmonary embolism．Emerg Med,1998;16:27-31
2.王辰．肺栓塞．北京：人民卫生出版社，2003;267-279
3. Ghaye B，Remy J，Remy—Jardin M．Non—traumatic thoracic emergencies：CTdiagnosis of acute pulmonary embolism：the first10years．Eur Radiol,2002;1886—1905．
4. ChaeEJ, SeoJB, JangYM,et al. DualenergyCTforassess ent of theseverity of acutepulmonary embolism: pulmonary perfusion defect score copared with CTangiographic obstruction score and right ventricular/left ventriculardia eterratio. AJRAm J Roentgenol,2010;194(3):604-610
5.弥龙,宋云龙,王东等.双能量CT肺灌注成像评价急性肺栓塞严重程度的可行性研究,解放军医学杂志,2011;36(5):526-529
6.赵殿江,马大庆,贺文,等CT肺血管造影对急性肺栓塞患者右室功能障碍的评价,实用放射学杂志,2008;24(2):168-172
7. Büller HR, Agnelli G, Hull RD. Antithrombotic therapy for venousthromboembolic disease: the Seventh ACCP Conference on Anti-thrombotic andThrombolytic Therapy. Chest,2004;126:401S–28S.
8. Rafique M, Middlemost S, Skoularigis J, Sareli P. Simultaneous mechanical clotfragmentation and pharmacologic thrombolysis in acute massive pulmonaryembolism. Am J Cardiol,1992;69:427-430.
9. Brady AJ, Crake T, Oakley CM. Percutaneous catheter fragmentation of massivepulmonary embolus. Lancet,1992;339:1053-1054.
10. William TK, Michael KG, John DL, Jarrett KR, Daniel YS and Lawrence VH.Catheter-directed Therapy for the Treatment of Massive Pulmonary Embolism:Systematic Review and Meta-analysis of Modern Techniques. J Vasc Interv Radiol,2009;20:1431–1440.
11. William TK, Maurice AAJ, Lawrence VH. Catheter-Directed Embolectomy,Fragmentation, and Thrombolysis for the Treatment of Massive Pulmonary EmbolismAfter Failure of Systemic Thrombolysis. Chest,2008;134;250-254.
12. Zhou WZ, Shi HB, Yang ZQ, Liu S, Zhou CG, Zhao LB, et al. Value ofpercutanous catheter fragmentation in the management of massive pulmonaryembolism. Chin Med J,2009;122(15):1723-1727.
13. Schmitz-Rode T, Janssens U, Schild HH, Bache S, Hanrath P,Gunther RW.Fragmentation of massive pulmonary embolism using a pigtail rotation catheter.Chest,1998;114:1427-1436.
14. Moser KM．Venous thromboembolism． Am Rev Respir Dis,1990；141:235—249．
15. Dalen JE，Alpert JS．Natural history of pulmonary embolism．Progr CardiovascDiS,1975;17:259—270．
16. Carson JL，Kelley MA，Duff A， et a1．The clinical course of pulmonaryembolism．N Engl J Med,1992;326:1240～1245．
17. Matsumoto AH，Tegtmeyer CJ．Contemporary diagnostic approaches to acutepulmonary emboli．Radiol Clan North Am,1995;33:167—183．
18. Kanne JP, Gotway MB, Thoongsnwan W, et aL. Six cases of acute pulmonaryembolism revealed on unenhanced multi-detector CT of the chest．AJR,2003;180(6):1661-1666.
19. Goodman LR，Curtin JJ，Mewissen MW， et a1．Detection of pulmonaryembolism in patients with unresolved clinical and scintigraphic diagnosis：helical CTversus angiography．Am J Roentgenol,1995;164:1369一1374．
20. Sostman HD，Layish DT，Tapson FV， et a1．Prospective comparison of helicalCT and MR imaging in clinically suspected acute pulmonary embolism．J MagnResort Imaging,1996;6:275—281．
21. Van Rossum AB，Treurnie FE，Kieft GJ，et a1．Role of spiral volumetric computedtomographic scanning in the assessment of patients with clinical suspicion ofpulmonary embolism and an abnormal ventilation／perfusion1ung scan．Thorax,1996:51:23—28．
22.Van Rossum AB，Pattynama PM，Wjin A，et a1．Pulmonary embolism：validationof spiral CT angiography in149patients．Radiology,1996;201：467—470．
23. Christ Jansen F．Diagnostic imaging of acute pulmonary embolism．Acta Radiol,1997;38(Suppl):1-33．
24. Ghaye B, Ghuyson, Willems V. Severe pulmonary embolism：pulmonary arteryclot load scores and cardiovascular parameters predictors of mortality. Radiology,2006;239:884-891.
25. Schopf UJ, Costello P. Multidetector-row CT imaging of pulmonary embolism.Semin Roentgenol,2003;38:106.
26. WuAS, Pezzullo JA, Cronan JJ. CT pulmonary angiography: quantification ofpulmonary embolus as a predictor of patient out-come-initial experience. Radiology,2004;230:831-835.
27. Cornelia SP, Mathias Prokop. MDCT for the diagnosis of acute pulmonaryembolism. Eur Radiol Suppl,2005; D21-4.
28. Bankier AA, Janata K, Fleischman D, Kreuser S, Mallek R, Frossard M, et al.Severity assessment of acute pulmonary embolism with spiral CT: evaluation of twomodified angiographic scores and comparison with clinical data. J Thorac Imaging,1997;12:150–158.
29. Quanadli SD, El Hajjam M, Vieillard Baron A, Joseph T, Mesurolle B, Oliva VL,et al. New CT index to quantify arterial obstruction in pulmonary embolism:comparison with angiographic index and echocardiography. Am J Roentgenol,2001;176:1415–1420.
30. Zafiria MM, Miltos PV, George CM, Froso GK, Stauros HC, Afroditi K, et al.Acute Pulmonary Embolism: Correlation of CT Pulmonary Artery Obstruction Indexwith Blood Gas Values. Am J Roentgenol,2006;186:213–219.
31. Cela MC, Amplatz K. Nonsurgical pulmonary embolectomy. In: Cope C, eds.Current techniques in interventional radiology. Philadelphia: Current Medicine,1994;1-12
32. Hyers TM. Venous thromboembolism. Am J Respir Crit Care Med,1999;159:1–14.
33. Goldhaber SZ, Haire WD, Feldstein ML. Alteplase versus heparin in acutepulmonary embolism: randomized trial assessing rightventricular function andpulmonary perfusion. Lancet,1993;341:507–11.
33. Schmitz-Rode T, Janssens U, Schild HH. Fragmentation of massive pulmonaryembolism using a pigtail rotation catheter. Chest,1998;114:1427–1436.
34. Stock KW, Jacob AL, Schnabel KJ. Massive pulmonary embolism: treatment withthrombus fragmentation and local fibrinolysis with recombinant human-tissueplasminogen activator. Cardiovasc Intervent Radiol,1997;20:364–368.
35. Elliott CG. Pulmonary physiology during PE. Chest,1992;101:163s–71s.
36. Wells PS, Anderson DR, Rodger M, et al. Derivation of a simple clinical model tocategorize patients’ probability of pulmonary embolism: increasing the model’s utilitywith the SimpliRED D-dimer. Thromb Haemost,2000;83:416–20.
37.Douma RA, Gibson NS, Gerdes VEA. Validity and clinical utility of the simplifiedWells rule for assessing clinical probability for the exclusion of pulmonary embolism.Thromb Haemost,2009;101:197–200.
38. Miller GA, Sutton GC, Kerr IH, Gibson RV, Honey M. Comparison ofstreptokinase and heparin in treatment of isolated acute massive pulmonary embolism.Br Med J,1971;2:681–4.
39. Kasper W, Meinertz T, Henkel B. Echocardiographic findings in patients withproved pulmonary embolism. Am Heart J,1986;112:1284–90.
40. Ioana M, Martine RJ, Pascal M, Eric G, Valerie D, Jean-Jacques B, et al. Severityof acute pulmonary embolism: evaluation of a new spiral CT angiographic score incorrelation with echocardiographic data. Eur Radiol,2003;13:29–35.
41. Van Rossum AB, Pattynama PMT, Ton ET, Kieft GJ. Spiral CT appearance ofresolving clots at6-week follow-up after acute pulmonary embolism. J Comput AssistTomogr,1998;22:413–417.
42. Remy-Jardin M, Louvegny S, Remy J, Artaud D, Deschildre F, Bauchart JJ et al.Acute central thromboembolic disease: posttherapeutic follow-up with spiral CTangiography. Radiology,1997;203:173–180.
1．Anderson FA Jr,Wheeler HB, Goldberg RJ,et al. A population based perspective ofthe hospital incidence and case fatality rates of deep vein thrombosis and pulmonaryembolism. The Worcester DVT Study. Arch Intern Med,1991;151(5):933-938
2.Remy-Jardin M, Mastora I, Remy J. Pulmonary embolus imaging with multisliceCT. Radiol Clin North Am,2003;41(3):507-519
3.European Society of Cardiology. Guidelines on diagnosis and management of acutepulmonary embolism. Eur Heart J,2000;21:1301-06
4.Mayo JR, Remy-Jardin M，Muller VT，et al. Pulmonary embolism: prospectivecomparision of spiral CT with ventilation-perfusion scinigraphy. Radiology,1997;205:447-452.
5.Schibany N, Fleischmann D, Thallinger C,et al. Equiment availability anddiagnostic strategies for suspected pulmonary embolism in Austria.EurRadiol,2001;11:2287-2294
6．Ruiz Y, Caballero P, Caniego JL, et al. Prospective comparison of helical CT withangiography in pulmonary embolism: global and selective vascular territory analysis.Interobserver agreement. Eur Radiol,2003;13(4):823-9.
7.PIOPED investigators. Value of the ventilation/perfusion scan in acute pulmonaryembolism.JAMA,1990;263:2753.
8．Blachere H, Latrabe V, Montaudon M,et al. Pulmonary embolism revealed onhelical CT angiography:comparison with ventilation-perfusion radionuclide lungscanning. AJR,2000;174:1041-1047.
9．Reittner P, Coxson HO, Nakano Y, et al. Pulmonary embolism: comparison ofgadolinium-enhanced MR angiography with contrast-enhanced spiral CT in a porcinemodel. Acad Radiol,2001;8:343-350.
10.Bova C, Greco F, Misuraca G, et al. Diagnosis utility of echocardiography inpatients with suspected pulmonary embolism.AmJ Emerg Med,2003;21:180-183
11.Mayo JR, Remy Jardin M, Muller NL, et al. Pulmonary embolism: prospectivecomparision of spiral CT with ventilation/perfusionscintigraphy.Radiology,1997;205:447-452.
12．Herzog P, Wildberger JE, Niethammer M, et al.CT perfusion imaging of the lungin pulmonary embolism. Acad Radiol,2003;10:1132-1146.
13.Fleischmann D, Use of high concentration contrast media: principles andrationale-vascular district. Eur Radiol,2003;45(suppl1):S88-93.
14.Garg K, Macey L, Helical CT scanning in the diagnosis of pulmonary embolism.Respiration,2003;70:231-237.
15.Perrier A, Nendaz MR, Sarasin FP,et al.Cost-effectiveness analysis of diagnosticstraregies for suspected pulmonary embolism including helical computed tomography.Am J Respirat Crit Care Med,2003;167:39-44.
16.Galvin JR, Gingrich RD, Hoffman E, et al. Ultrafast computed tomography of thechest. Radiol Clin North Am,1994;32:775.
17.Ruiz Y, Caballero P, Caniego JL, et al. Prospective comparison of helical CT withangiography in pulmonary embolism: global and selective vascular territory analysis.Interobserver agreement. Eur Radiol,2003;13:823.
18.Qanadli SD, Hajjam ME, Mesurolle B, et al. Pulmonary embolism detection:prospective evaluation of dual-section helical CT versus selective pulmonaryarteriography in157patients. Radiology,2000;217:447
19.Ghaye B, Szapiro D, Mastora I, et al. Peripheral pulmonary arteries: how far in thelung does multi-detector row spiral CT allow analysis? Radiology,2001;219:629.
20.Schoepf UJ, Kessler MA, Rieger CT,et al. Multislice CT imaginging of pulmonaryembolism. EurRadiol,2001;11:2278-2286.
21.Kruip MJ, Slob MJ, Buller HR, et al. A prospective clinical study on the feasibilityand safety of a combined noninvasive/pulmonary angiography strategy in patientswith suspected pulmonary embolism:an interim analysis. ClinAppl Thromb Hemost,1999;5:222-225.
22.Gulsun M, Goodman LR, Washington L. Venous thromboembolic disease: wheredoes multidetector computed tomography fit? Cardiol in,2003;21:631-638.
23.王辰，主编，肺栓塞，北京，人民卫生出版社，2003;263-279.
24.Reid JH, Murchison JT. Acute right ventricular dilation: a new helical CT sign ofmassive pulmonary embolism. Clin Radiol,1998;53:694-698
25.周旭辉，李菁，李子平等。急性肺动脉栓塞的CT表现与疾病严重程度的关系。中华放射击学杂志，2006;40（9）:918-922。
26.Ghuysen A, Ghaye B, Willems V, et al. Computed tomographic pulmonaryangiography and prognostic significance in patients with acute pulmonary embolism.Thorax,2005Nov;60(11):956-961.
27.Van der Meer RW, Pattynama PM, van Strijen MJ, et al. Right ventriculardysfunction and pulmonary obstruction index at helical CT: prediction of clinicaloutcome during3-month follow-up in patients with acute pulmonary embolism.Radiology.2005Jun;235(3):798-803.
28.Samuel Z Goldhaber. Pulmonary Embolism. Lancet,2004;363:1295-305.
29.Kavangh EC, O’Hare A, Hargaden G, et al. Risk of pulmonary embolism afternegative MDCT pulmonary angiography findings. AJR,2004;182:499-504.
30.RemyJM, Tillie LI, Szapiro D, et al. CTangiography of pulmonary embolism inpatients with underlying respiratory disease:impact of multislice CT on image qualityand negative predictive value. Eur Radoil,2002;12:1971-1978
31.Tillie LI, Mastora I,Radenne F, et al. Risk of pulmonary embolism after a negativespiral CT angiogram in patients with pulmonary disease:1year clinical follow-upstudy. Radiology,2002;223:461-467.
32.Kruip MJ, Leclercq MG, Van Der Heul C, et al. Diagnostic strategies for excludingpulmonary embolism in clinical outcome studies,a systematic review. Ann Intern Med,2003;138:941-951.
33.Greco F, Zanolini A, Bova C, et al. combined diagnostic approach to venousthromboembolism with multidetector computed tomography. Ital Heart J,2003;4:226-231.
34.Wildberger JE, Niethammer MU, Klotz E, et al, Multi-Slice CT for Visualizationof Pulmonary embolism Using Perfusion Weighted Color Maps. Fortschr Rntgenstr,2001;173(9):289-294.
35.Wildberger JE, Klotz E, Ditt H, et al. Multislice computed tomography perfusionimaging for visualization of acute pulmonary embolism: animal experience. EurRadiol,2005;15(7):1378-1386.
36.Thieme SF, Ashoori N, Bamberg F, et al. Severity assessment of pulmonaryembolism using dual energy CT-correlation of a pulmonary perfusion defect scorewith clinical and morphological parameters of blood oxygenation and rightventricular failure. Eur Radiol,2012Feb;22(2):269-278
37.Hoey ET, Mirsadraee S, Pepke-Zaba J, et al. Dual-energy CT angiography forassessment of regional pulmonary perfusion in patients with chronic thromboembolicpulmonary hypertension: initial experience,2011Mar;196(3):524-532
38. Bauer RW, Kerl JM, Weber E, et al. Lung perfusion analysis with dual energy CTin patients with suspected pulmonary embolism--influence of window settings on thediagnosis of underlying pathologies of perfusion defects. Eur J Radiol,2011Dec;80(3):e476-482
39.Shahir K, Goodman LR, Tali A, et al. Pulmonary embolism in pregnancy: CTpulmonary angiography versus perfusion scanning. AJR Am J Roentgenol,2010;195(3):W214-220
40.Cham MD, Yankelevitz DF, Henschke CL, et al. Indirect venography: consistentdetection of DVT in suspected pulmonary embolism.RSNA,2002;151:174
41.Kevin M, Duwe MS, Nancy E,et al. Evaluation of the lower extremity veins inpatients with suspected pulmonary embolism. AJR,2000;175:1525-1531.
42. Katz DS, Loud PA, Bruce D,et al, Combined CT venography and pulmonaryangiography: a comprehensive review. Radiographics,2002Oct;22Spec No:S3-19
43. Wildberger JE, Klotz E, Ditt H, et al. Multi-slice CT for visualization of acutepulmonary embolism: single breath-hold subtraction technique. Rofo,2005;177(1):17-23.
44.Chiang EE, Boiselle PM, Raptopoulos V, et al. Detection of pulmonary embolism:comparison of paddlewheel and coronal CT reformation-Initialexperience. Radiology,2003;228(2):577-582.
45.吴春根,周康荣,汤敏.心电标记回顾性肺动脉多层螺旋CT血管造影术(附5例肺动脉栓塞).临床放射学杂志,2003;22:287
46.Patel S, Kazerooni EA, Cascade PN, et al. Pulmonary embolism: optimization ofsmall pulmonary artery visualization at multi-detector row CT. Radiology,2003;227(2):455-60.
47.Schoepf UJ, Costello P. Spiral computed tomography is the first-line chestimaging test for acute pulmonary embolism:yes.J Thromb Haemost,2005;3:7-10.
48.Hartmann IJ, Wittenberg R, Schaefer-Prokop C. Imaging of acute pulmonaryembolism using multi-detector CT angiography: An update on imaging technique andinterpretation,2010Mar11.[Epub ahead of print]
49.Todoran TM, Sobieszczyk P. Catheter-based therapies for massive pulmonaryembolism,2010Mar-Apr;52(5):429-437.
50. Porres-Aguilar M, Munoz OC, Alvarez P, et al. Successful percutaneousmechanical thrombectomy in a haemodynamically unstable patient with massivepulmonary embolism,2010Feb7.[Epub ahead of print]
51. Bazeed MF, Saad A, Sultan A,et al. Prediction of pulmonary embolism outcomeand severity by computed tomography. Acta Radiol,2010Apr;51(3):271-276.
52. Stein P D, Fowler S E, Goodman L R, et al. Multidetector computed tomographyfor acute pulmonary embolism. N Engl J Med,2006;35:2317-232
1. Ghaye B，Remy J，Remy—Jardin M．Non—traumatic thoracic emergencies：CTdiagnosis of acute pulmonary embolism：the first10years．Eur Radiol,2002;1886—1905．
2. Moser KM． Venous thromboembolism． Am Rev Respir Dis,1990;141:235—249．
3. Dalen JE， Alpert JS． Natural history of pulmonary embolism．Progr CardiovascDiS,1975;17:259—270．
4. Carson JL，Kelley MA，Duff A， et a1．The clinical course of pulmonaryembolism．N Engl J Med,1992;326:1240-1245．
5. Matsumoto AH，Tegtmeyer CJ．Contemporary diagnostic approaches to acutepulmonary emboli．Radiol Clan North Am,1995;33:167-183．
6. Urokinase Pulmonary Embolism Trial．A National Cooperative Study．Circulation,1973;47(Suppl2):1-108．
7. Gervifl AS．Complications of heparin therapy．Surg Gynecol Obstet,1975;140:789-796．
8. Kashtan J， Conti S， Blaisdell FW． Heparin therapy for deep venousthrombosis．Am J Surg,1980;140:836-840．
9. Cheely R，McCartney wH，Perry JR，et a1．The role of noninvasive tests versuspulmonary angiography in the diagnosis of pulmonary embolism．Am J Med,1981;70:17-22．
10. Fihn SD，McDonell M，Martin D，et a1．Risk factors for complications of chronicancoagulation．A multicenter study．Warfarin optimized outpatient follow—up studygroup．Ann Intern Med,1993;18:511-520．
11. Landefeld CS， Beyth RJ． Anticoagulant—related bleeding： clinicalepidemiology，prediction and prevention．Am J Med,1993;95:315-328．
12.Blachere H， Latrabe V， Montaudon M， et al．Pulmonary embolism revealedon helicalCT angiography：comparison with ventilation-perfusion radionuclide lungscanning[J]. Am J Roentgenol,2000;174(4):1041-1047.
13. Ghaye B, Szapiro D, Mastora I, et al. Peripheral pulmonary arteries: how far inthe lung does multi-detector row spiral CT allow analysis. Radiology,2001;219(3):629.
14. Patel S, Kazerooni E, Cascade P. Pulmonary embolism: optimization of smallpulmonary artery visualization at multi-detector row CT. Radiology,2003;227(2):455.
15. Jones Stephen E, Jones, Wittram Conrad, et al. The inderterminate CT pulmonaryavgiogram: imaging characteristics and patient clinical outcome. Radiology,2005;237:329-337.
16. Blachere H, Latrabe V, Montaudon M, et al. Pulmonary embolism revealed onhelical CT angiography: comparison with ventilation-perfusion radionuclide lungscanning. AJR,2000;174:1041-1047.
17. Schoellnast Helmut, Defutschmann Hnnes A, Fritz Gerald, et al. MDCTangiography of the pulmonary arteries: influence of iodine flow concentration onvessel attenuation and visualization. AJR,2005;84:1935-1939.
18. Patel S，Kazerooni EA，Cascade PN．Pulmonary embolism：optimization of smallpulmonary artery visualization at multi-detector row CT．Radiology,2003;227(2):455-460．
19. Schoepf UJ，Holzknecht N，Helmberger TK，et al. Sub-segmental pulmonaryemboli： improved detection with thin-collimation multi-detector row spiralCT．Radiology,2002;222(2):483-490．
20. Kanne JP, Gotway MB, Thoongsnwan W, et aL. Six cases of acute pulmonaryembolism revealed on unenhanced multi-detector CT of the chest[J]．AJR,2003;180(6):1661-1666.
21. Goodman LR，Curtin JJ，Mewissen MW， et a1．Detection of pulmonaryembolism in patients with unresolved clinical and scintigraphic diagnosis：helical CTversus angiography．Am J Roentgenol,1995;164:1369-1374．
22. Sostman HD，Layish DT，Tapson FV， et a1．Prospective comparison of helicalCT and MR imaging in clinically suspected acute pulmonary embolism．J MagnResort Imaging,1996;6:275-281．
23. Van Rossum AB，Treurnie FE，Kieft GJ，et a1．Role of spiral volumetric computedtomographic scanning in the assessment of patients with clinical suspicion ofpulmonary embolism and an abnormal ventilation/perfusion1ung scan．Thorax,1996;51:23-28．
24.Van Rossum AB，Pattynama PM，Wjin A，et a1．Pulmonary embolism：validationof spiral CT angiography in149patients．Radiology1996：201：467—470．ChristJansen F．Diagnostic imaging of acute pulmonary embolism．Acta Radiol,1997;38(Suppl):1-33．
25. Christ Jansen F．Diagnostic imaging of acute pulmonary embolism．Acta Radiol,1997;38(Suppl):1-33．
26. Pruszczyk P，Torbicki A，Pacho R, et al， Noninvasive diagnosis of suspectedsevere pulmonary embolism．Chest,1997;112:722-728．
27. Garg K，Welsh CH，Feyerabend AJ, et a1．Pulmonary embolism：diagnosis withspiral CT and ventilation—perfusion scanning： correlation with pulmonaryangiographic results of Clinical outcome．Radiology,1998;208:20l-208．
28.Herold CJ，Hahne J， Ghaye B, et a1．Prospective evaluation of pulmonaryembolism： diagnostic performance of spiral CT angiography in the ESTIPEPtrial．Radiology,1999;213(Suppl):126-127.
29. Kim KI，Müller NL．Mayo JR．C1inically suspected pulmonary embolism：utilityof spiral CT．Radiology,1999;210:693-697．
30. Blachere H，Latrabe V， Montaudon M， et a1．Pulmonary embolism revealedon helical CT angiography： comparison with ventilation—perfusion radionuclidelung scanning．Am J Roentgenol,2000;174:1041-1047．
31. Qanadli SD, EI Hajjam M，Mesurolle B，et a1．Pulmonary embolism detection：prospective evaluation of dual-section helical CT versus selective pulmonaryarteriography in157patients．Radiology,2000;217:447-455．
32. Remy—Jardin M， Remy J， Baghaie F， et a1． Clinical value of thincollimation in the diagnostic workup of pulmonary embolism．Am J Roentgenol,2000;175:407-411．
33. Van Strijen．MJ, De Monye W，Kieft GJ，et a1．Diagnosis of pulmonary embolismwith spiral CT：a prospective cohort study in617consecutive patients．Radiology,1999;213(Suppl):128．
34. Perrier A，Howarth N，Didier D，et a1．Performance of helical computedtomography in unselected outpatients with suspected pulmonary embolism．AnnIntern Med,2001;135:88-97．
35. Kauczor HU，Heussel CP，Thelen M．Update on diagnostic strategies ofpulmonary embolism．Eur Radiol,1999;9:262-275．
36. Miller GA，Sutton GC，Kerr lH，et a1．Comparison of streptokinase and heparinin treatment of isolated acute massive pulmonary embolism．Br Med J,1971;2(763):681-684.
37.Walsh PN，Greenspan RH，Simon M．et a1．An angiographic severity index forpulmonary embolism[J]．Circulation,1973,47(suppl II):101-107.
38. Bankier AA，Janata K，Fleischmann D，et a1．Severity assessment of acutepulmonary embolism with spiral CT：evaluation of two modified angiographic scoresand comparison with clinical data[J]．J Thorac Imaging,1997;12(2):150-158.
39. Qanadli SD，El Hjjam M，Vieillard—Baron A，et a1．New CT index to quantifyarterial obstruction in pulmonary embolism：comparison with angiographic index andechocardiography[J]．Am J Roentgenol,2001;176(6):1415-1420．
40. Mastora I，Remy-Jardin M，Masson P，et a1．Severity of acute pulmonaryembolism：evaluation of a new spiral CT angiographic score in correlation withechocardiographic data[J]．Eur Radiol,2003;13(1):29-35．
41. Collomb D，Paramelle PJ，Galaque O et a1．Severity assessment of acutepulmonary embolism：evaluation using helical CT．Eur Radiol,2003;13（7）:1508-1514．
42. Metafratzi ZM，Vassiliou M P，M aglaras GC，et a1．Acute pulmonary embolism：correlation of CT pulmonary artery obstruction index with blood gas values．Am JRoentgenol,2006;186(1):213-219．
43.张辉，邹利光，逢鑫等，多层螺旋CT血管造影对肺动脉栓塞诊断和疾病严重程度的评价价值，第三军医大学学报，2009;31（21）:2053-2056.
44.Lualdi JC, Goldhaber SZ. Right ventricular dysfunction after acute pulmonaryembolism: pathophysiologic factors, detection, and therapeutic implications. AmHeart J,1995;130:1276–1282.
45.Kasper W, Meinertz T, Henkel B, et al. Echocardiographic findings in patientswith proved pulmonary embolism. Am Heart J,1986;112:1284–1290.
46.Cela MC， Amplatz K．Nonsurgical pulmonary embolectomy ［M］//Cope C,ed．Current Techniques in Interventional Radiology．Philadelphia：Current Medicine,1994;1-12．
47.Dalen JE， Alpert JS． Natural history of pulmonary embolism．Prog CardiovascDis,1975;17:259-270．
48. Hartmann IJ, Wittenberg R, Schaefer-Prokop C. Imaging of acute pulmonaryembolism using multi-detector CT angiography: An update on imaging technique andinterpretation. Eur J Radiol,2010; Mar11.[Epub ahead of print]
49. Todoran TM, Sobieszczyk P. Catheter-based therapies for massive pulmonaryembolism,2010Mar-Apr;52(5):429-437.
50. Porres-Aguilar M, Munoz OC, Alvarez P, et al. Successful percutaneousmechanical thrombectomy in a haemodynamically unstable patient with massivepulmonary embolism. Respirology,2010Feb7.[Epub ahead of print]
51. Bazeed MF, Saad A, Sultan A,et al. Prediction of pulmonary embolism outcomeand severity by computed tomography. Acta Radiol,2010Apr;51(3):271-276.
52.王庆庆，施海彬，周卫忠，等。单纯经皮机械祛栓治疗急性大面积肺栓塞的临床应用。介入放射学杂志,2010;19（4）:291-295
53. William TK, Michael KG, John DL, Jarrett KR, Daniel YS and Lawrence VH.Catheter-directed Therapy for the Treatment of Massive Pulmonary Embolism:Systematic Review and Meta-analysis of Modern Techniques. J Vasc Interv Radiol,2009;20:1431–1440.
54. William TK, Maurice AAJ, Lawrence VH. Catheter-Directed Embolectomy,Fragmentation, and Thrombolysis for the Treatment of Massive Pulmonary EmbolismAfter Failure of Systemic Thrombolysis. Chest,2008;134:250-254.
55. Zhou WZ, Shi HB, Yang ZQ, Liu S, Zhou CG, Zhao LB, et al. Value ofpercutanous catheter fragmentation in the management of massive pulmonaryembolism. Chin Med J,2009;122(15):1723-1727.
56. Rafique M, Middlemost S, Skoularigis J, Sareli P. Simultaneous mechanical clotfragmentation and pharmacologic thrombolysis in acute massive pulmonaryembolism. Am J Cardiol,1992;69:427-430.
57. Brady AJ, Crake T, Oakley CM. Percutaneous catheter fragmentation of massivepulmonary embolus. Lancet,1992;339:1053-1054.
58. Schmitz-Rode T, Janssens U, Schild HH, Bache S, Hanrath P,Gunther RW.Fragmentation of massive pulmonary embolism using a pigtail rotation catheter.Chest,1998;114:1427-1436.
59.张学彬，吕维富，孙一兵，等．经皮介入碎栓及溶栓治疗大面积肺栓塞，介入放射学杂志，2005；14：39-42．
60. Goldhaber SZ． Percutaneous mechanical thrombectomy for massivepulmonary embolism improve safety and efficacy by sharinginformation． Catheter Cardiovasc Interv,2007;70:807-808．
61.弥龙,宋云龙,王东等.双能量CT肺灌注成像评价急性肺栓塞严重程度的可行性研究,解放军医学杂志,2011;36(5):526-529
62.吴京兰,谭四平,沈比先等.双源CT双能量肺灌注成像技术诊断急性肺动脉栓塞的临床应用.临床心血管病杂志,2011;27(5):385-388
63. Clough A V, Hawort S T, Roerig D L, et al. Influenceof gravity onradiographiccontrast mate rial based measurement of regional blood flowdistribution. Acad Radiol,2003;10:128-138.
64. Stein P D, Fowler S E, Goodman L R, et al. Multidetector computed tomographyfor acute pulmonary embolism. N Engl J Med,2006;35:2317-2327
65. Pontana F, Faiver J B, Remyjardin M, et al. Lung perfusion with dual energymultidetector row CT (MDCT): feasibility for the evaluation of acute pulmonaryembolism in117consecutive patients. Acad Radiol,2008;15:19–150
66. Wildberger J E, Niethammer M U, Klota Z E, et al. Multislice CT forvisualization of pulmonary embolism using perfusion weighted color map. Rofo,2001;173:289-293
67. Thieme S F, Becker C R, Hacker M, et al. Dual energy CT for the assessment oflung perfusion correlation to scintigraphy. Eur J Radiol,2008;68:3692-3741
68. Thieme SF, Ashoori N, Bamberg F, et al. Severity assessment of pulmonaryembolism using dual energy CT-correlation of a pulmonary perfusion defect scorewith clinical and morphological parameters of blood oxygenation and rightventricular failure. Eur Radiol,2012Feb;22(2):269-78
69. Hoey ET, Mirsadraee S, Pepke-Zaba J, et al. Dual-energy CT angiography forassessment of regional pulmonary perfusion in patients with chronic thromboembolicpulmonary hypertension: initial experience. AJR Am J Roentgenol,2011Mar;196(3):524-532
70. Bauer RW, Kerl JM, Weber E, et al. Lung perfusion analysis with dual energy CTin patients with suspected pulmonary embolism--influence of window settings on thediagnosis of underlying pathologies of perfusion defects. Eur J Radiol,2011Dec;80(3):e476-482
71. Shahir K, Goodman LR, Tali A, et al. Pulmonary embolism in pregnancy: CTpulmonary angiography versus perfusion scanning. AJR Am J Roentgenol,2010;195(3): W214-220
72. Chae EJ, Seo JB, Jang YM, et al. Dual-energy CT for assessment of the severityof acute pulmonary embolism: pulmonary perfusion defect score compared with CTangiographic obstruction score and right ventricular/left ventricular diameter ratio.AJR Am J Roentgenol,2010;194(3):604-610