目的 分析多层螺旋CT图像后处 理技术在肺栓塞诊断中的应用价值。方 法 回顾性分析2012年7月-2015年6月甘 肃省人民医院收治的48例肺栓塞患者的 临床资料，入院后所有患者均已接受多 层螺旋CT检查，图像给予最大密度投影 (MIP)、多平面重建(MPR)及容积再现(VR) 后处理，分析不同后处理技术对肺栓塞的 诊断价值。结果 48例肺栓塞患者共发现 累及各级肺动脉分支栓子491处，VR重建 对肺段动脉、亚段动脉栓子检出率低于 MPR与MIP，VR对肺栓塞栓子整体检出率为 81.1%，低于MPR与MIP重建，对比差异有 统计学意义(P<0.05)；491处肺栓子直接 征象以偏心性充盈缺损多见，其次为完全 性栓塞、中心性充盈缺损，附壁血栓较少 见；间接征象包括肺梗塞、肺动脉高压、 肺动脉增粗、胸腔积液、肺纹理局限性稀 疏、支气管动脉扩张。结论 采用多层螺 旋CT诊断肺栓塞敏感度、特异性高，且安 全、无创，图像质量高，分辨率高，同时 配合MPR、MIP后处理，可提高亚段动脉栓 子检出率。

Objective To analyze the application value of multi-slice spiral CT image postprocessing techniques in the diagnosis of pulmonary embolism. Methods The clinical data of 48 patients with pulmonary embolism treated in the People's Hospital of Gansu from July 2012 to June 2015 were analyzed retrospectively. All patients were examined with multi-slice CT after admission, and images were processed by the maximum intensity projection (MIP), multi-planar reconstruction (MPR) and volume rendering (VR) postprocessing techniques. The value of different postprocessing techniques in the diagnosis of pulmonary embolism was analyzed. Results There were a total of 491 emboli involving different levels of pulmonary artery branches in 48 patients with pulmonary embolism. The detection rates of pulmonary segment artery and sub-segment artery emboli by VR were lower than those by MPR and MIP, and the overall detection rate of the pulmonary embolism emboli by VR was 81.1%, lower than that of MPR and MIP reconstruction (P<0.05). Eccentric filling defect was the most common direct sign of 491 pulmonary embolism emboli, followed by complete embolism and central filling defect, and mural thrombus was rare. Indirect signs included pulmonary infarction, pulmonary hypertension, pulmonary artery thickening, pleural effusion, limited sparse lung texture and bronchial artery dilatation. Conclusion The sensitivity and specificity of multi-slice spiral CT are high in the diagnosis of pulmonary embolism, safe and non-invasive. The image quality and resolution are high. It can be combined with MPR and MIP postprocessing techniques to improve the detection rate of sub arterial emboli.