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DOI: 10.1055/s-2002-33952
© Georg Thieme Verlag Stuttgart · New York
CT-Venographie und CT-Angiographie der Pulmonalarterien in der Diagnostik der akuten Lungenarterienembolie
CT Venography and CT Angiography of the Pulmonary Arteries in Acute Pulmonary EmbolismPublication History
Publication Date:
09 September 2002 (online)
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Zusammenfassung
Ziel: Ermittlung der diagnostischen Wertigkeit einer CT-Venographie der unteren Extremitäten mittels Mehrschicht-Spiral-CT im Rahmen einer CT-Angiographie der Pulmonalarterien bei der Verdachtsdiagnose der akuten Lungenarterienembolie.
Methodik: Von September 1999 bis April 2001 wurde bei 252 Patienten eine CT-Angiographie der Pulmonalarterien in Kombination mit einer CT-Venographie der V. cava, der V. iliaca und der proximalen V. femoralis bzw. seit April 2000 zusätzlich der V. poplitea einschließlich der proximalen Unterschenkelvenen durchgeführt. Die Untersuchungen erfolgten an einem Doppeldetektor- bzw. Multidetektor-Spiral-CT (Elscint Twin bzw. GE Lightspeed).
Ergebnisse: In 79/252 Fällen wurde die Verdachtsdiagnose Lungenarterienembolie bestätigt (40 zentrale und 39 segmentale/subsegmentale LAE). Bei 38/40 zentralen LAE und bei 22/39 segmentalen/subsegmentalen LAE fand sich in der CT-Venographie eine tiefe Venenthrombose, in 1/79 eine gedoppelte V. cava. Bei 5 Patienten wurde eine Kavathrombose mittels temporärem Kavafilter versorgt. Bei 13/173 Patienten ohne Lungenembolie zeigte die CT-Venographie tiefe Thrombosen.
Schlussfolgerungen: Die Routine-CT-Venographie der unteren Extremität im Rahmen der Diagnostik der akuten Lungenarterienembolie erfasst therapierelevante Thrombosen mit einer hohen Sensitivität.
Abstract
Objectives: To determine the diagnostic value of CT venography after CT angiography of the pulmonary arteries using multislice helical CT in the diagnosis of acute pulmonary embolism.
Methods: Between September 1999 and April 2001 252 patients with clinically suspected pulmonary embolism were examined. CT angiography of the pulmonary arteries was followed by CT venography of the inferior vena cava, the iliac veins and the proximal femoral veins; after April 2000 the popliteal veins and the proximal lower leg veins were additionally investigated. The examinations were performed with a double detector and a multidetector scanner (Elscint Twin and GE Lightspeed).
Results: Pulmonary embolism was found in 79/252 patients (40 central and 39 segmental/subsegmental PE). In 38/40 patients with central PE and in 22/39 patients with segmental/subsegmental PE in CT venography a deep venous thrombosis was detected, in 1/79 patient a doubled inferior vena cava could be found. In 5 patients with thrombosis of the inferior vena cava a transjugular cava filter placement was performed. In 13/173 patients without pulmonary embolism CT venography showed deep venous thrombosis.
Conclusion: CT venography of the lower extremities is a practical and efficient additional examination to CT angiography in clinical suspected pulmonary embolism. It can detect the causing venous thrombosis with a high sensitivity.
Schlüsselwörter
Mehrschicht-Spiral-CT - CT-Angiographie - CT-Venographie - Lungenarterienembolie - Venenthrombose
Key words
Multislice CT - CT angiography - CT venography - pulmonary embolism - venous thrombosis
Literatur
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Dr. Lars Jonetz-Mentzel
Institut für Bildgebende Diagnostik
HELIOS Klinikum Erfurt GmbH
Postfach 10 12 63
Nordhäuser Straße 74
99012 Erfurt
Phone: 03 61/7 81 26 00
Fax: 03 61/7 81 26 02
Email: ljonetz@erfurt.helios-kliniken.de