| 摘要: |
| 目的对比肺通气/灌注平面显像与肺灌注SPECT-CT同机融合断层显像在慢性血栓栓塞性肺动脉高压肺段动脉及亚段动脉栓子的检出效能。方法选取经临床Wells评分、临床资料、实验室检查及X线肺动脉造影综合确诊为慢性血栓栓塞性肺动脉高压的35例患者,其中男25例,女10例,平均年龄（52.4±16.5）岁,合并近期手术者3例、心力衰竭者7例、既往存在急性肺栓塞10例、合并下肢深静脉血栓21例;临床Wells评分,高度可能性者15例,中度可能性者20例。所有患者均接受肺通气/灌注平面显像、肺灌注SPECT-CT断层同机融合显像及X线肺动脉造影检查,检查于5 d内完成并由核医学科及放射科有经验医师进行独立、双盲法阅片。采用SPSS19.0统计软件对肺通气/灌注平面显像、SPECT-CT同机融合显像及X线肺动脉造影段及亚段的检查结果进行Χ2检验及Kappa一致性检验。结果对于肺段动脉栓子,肺通气/灌注平面显像与肺灌注SPECT-CT的敏感度、特异度、准确度分别为89.63%、69.41%、77.14%;92.53%、93.57%、93.17%。亚段肺动脉栓子,肺通气/灌注平面显像与肺灌注SPECT-CT敏感度、特异度、准确度分别为60.97%、89.05%、82.14%;63.87%、94.0%、86.59%。结论肺灌注SPECT-CT在保留了肺通气/灌注平面显像对肺段及亚段病变定位较高的敏感性同时,提高了对肺段及亚段病变定位的特异性。 |
| 关键词: 肺栓塞 慢性 SPECT-CT 肺通气 灌注显像 肺动脉造影 |
| DOI：10.3969/j.issnl008-0392.2014.03.019 |
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| 基金项目: |
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| Comparison between pulmonary ventilation/perfusion scintigraphy and pulmonary perfusion SPECT-CT fusion imaging in localization of embolus in patients with chronic thromboembolic pulmonary hypertension |
| LUO Bi-jun |
| (Dept. of Emergency, Tenth People＇s Hospital, Tongji University, Shanghai 200072, China) |
| Abstract: |
| Objective To compare ventilation/perfusion scan and the pulmonary perfusion SPECTCT fusion imaging in localization of embolus in patients with chronic thromboembolic pulmonary hypertension.Methods Data of 35 consecutive patients with chronic thromboembolic pulmonary hypertension diagnosed by clinical assessment,laboratory examination and X-ray pulmonary angiography were retrospectively analyzed.The underlying conditions of 35 patients were recent surgery（3 cases）,comorbidity of heart-failure（7 cases）,previous coexistence of acute pulmonary embolism（10 cases） and lower limb deep vein thrombosis（11 cases）.Clinical Wells score indicated high probability in 15 cases and moderate possibility in 20 cases.All patients accepted V/Q imaging,pulmonary perfusion SPECT-CT fusion imaging and X-ray pulmonary angiographyin 5 days.The images of segmental and subsegmental pulmonary artery were independent reviewed by physicians of nuclear medicine and radiologists.SPSS 19.0 was used for the statistical analyses.Results All the patients successfully underwent the examinations.At the segmental level,the ventilation-perfusion V/Q scan had the diagnostic accuracy of 77.14%,sensitivity of 89.63% and specificity of 69.41%.The SPECT-CT fusion imaging had the diagnostic accuracy of 93.17%,sensitivity of 93.57% and specificity of 93.17%.At the subsegmental level,the ventilation-perfusion V/Q scan had the diagnostic accuracy of 82.14%,sensitivity of 60.97% and specificity of 89.05%.The SPECT-CT fusion imaging had the diagnostic accuracy of 86.59%,sensitivity of 63.87% and specificity of94.0%.Conclusion Pulmonary perfusion SPECT-CT fusion imaging has the same sensitivity as the ventilation/perfusion scan in localization of segment and sub-segment lesions,while improves the specificity of detection for patients with chronic thromboembolic pulmonary hypertension. |
| Key words: pulmonary hypertension chronic SPECT-CT pulmonary ventilation/perfusion scan pulmonary artery angiography |
