| Part 1 Imaging Comparison Study of Angiography ,EBCT, MRI and Ventilation/perfusion in Pulmonary embolismObjective: To evaluate the application value of Pulmonary angiography, electron beam computed tomographic(EBCT), MRI and perfusion scintigraphy in diagnosis of PE, including the basic index as sensitivity, specificity, total consistent rate and Agreement Kappa. Materials and Methods: The study protocol was approved by the Animal Ethical Committee of FUWAI Hospital, the animals were used and executed according to state guideline, the pulmonary embolism model were performed in 20 canines in routine method, animals underwent pulmonary angiography, electronic computed tomographic angiography, Gd-contrast enhanced Magnetic resonance angiography(Gd-CE-MRA) and ventilation-perfusion scintigraphy according to a strict protocol. The pulmonary artery system was anatomized from main pulmonary artery to the level of segmental or subsegmenal pulmonary artery, comparison between the results of pathology and other medical modalities were done respectively. Result: 16 of all canines successfully performed the whole procedures. 320 segmental pulmonary arteries were dissected , 91 embolus were detected in them and 12 of them lied in peristome of subsegmental pulmonary arteries. Pulmonary arteries: 85 embolus were detected and the sensitivity was 93.4%; EBCT: 86 embolus were found and the sensitivity was 94.5%; Gd-CE-MRPA: 67 segmental was detected with PE 73.6%; Ventilation-perfusion scintigraphy: 82 embolus were detected and the sensitivity was 90.1%. Conclusion: Compared with pathology anatomic data, goodish agreement were shown among Pulmonary angiography, EBCT, MRI and Ventilation-Perfusion scintigraphy. Differences in Sensitivity and specificity between pulmonary angiography and EBCT were not statistically significant and ETCT can be regarded as reference standard; pulmonary perfusion imaging scintigraphy is the valid compensation in diagnosis subsegmental pulmonary artery with PE when EBCT missed diagnosis. MRI was inferior to other medical modalities in sensitivity and may be the second-line modality in diagnosis of PE, however, its advantageous "one-stop shop service" can provide us with pathology and pathophisiology diagnosis as well as prognosis of PE, and is the most promising modality in diagnosis of PE.Part 2 Experimental study of intervention therapy for acute massive pulmonary embolismObjective: to compare the effective of catheter-directed thrombolysis and hybrid treatment for acute massive pulmonary embolism. Method: Cross-over design was adopted in this vitro experiment. 20 dogs were divided into two groups according to the protocol and were made into PE models. The group A were studied according to the process of catheter-directed thrombolysis→intermission (15 days)→hybrid treatment, Group B were studied according to another process: hybrid treatment→intermission (15 days)→catheter directed thrombolysis. the continuous change of pulmonary artery pressure and Miller score were recorded , the data analysis was done by change SPSS software package. Result: 3 dogs died from deteriorating of hemodynamic change and 2 of them died during the progress of catheter-directed thrombolysis in the second stage. The pulmonary artery mean pressure (PAMP)was 19.37±1. 5 mmHg in group A and 16.67±2.2 mmHg in Group B respectively at the end of the first stage ; the mean value of Miller score was 10.63±1. 41 in Group A and 8.67±1. 0 in Group B respectively at the end of the first stage, and the changes were significant difference. Conclusion: hybrid procedure can improve hemodynamic situation in patients with acute massive pulmonary embolism successfully and the results were significantly superior to those of catheter-directed thrombolysis. Hybrid treatment can get rid of residual thrombus more effectively and prevent chronic thromboembolic pulmonary hypertension probably.
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