肺通气灌注联合肺灌注融合断层显像与CT肺动脉造影对肺栓塞诊断价值的比较
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摘要
目的比较肺通气/灌注(V/Q)联合肺灌注单光子发射计算机断层显像联合同机CT融合断层显像(SPECT/CT)与螺旋CT肺动脉造影(CTPA)对肺栓塞的诊断价值。方法回顾性分析山西大医院2015年5月至2017年5月诊治的临床疑似肺栓塞患者60例的临床资料,患者均行V/Q显像及肺灌注SPECT/CT显像,并于3 d内完成CTPA检查,以最终临床综合诊断及随访证实有无肺栓塞,分别计算并比较两种显像方法对肺栓塞的诊断效能。结果 60例患者中,33例诊断为肺栓塞;V/Q联合肺灌注SPECT/CT融合断层显像的灵敏度、特异度、准确性分别为96. 97%(32/33)、92. 59%(25/27)、95%(57/60);CTPA的灵敏度、特异度、准确性分别为81. 82%(27/33)、92. 59%(25/27)、86. 67%(52/60);两者均无不确定诊断,两种检查方法在定性诊断肺栓塞方面差异无统计学意义(P> 0. 05)。V/Q联合肺灌注SPECT/CT融合断层显像共发现通气灌注不匹配肺段253个,亚肺段50个,其中15个V/Q不匹配肺段及5个亚肺段经肺灌注SPECT/CT融合断层图像证实由肺部病变所致(5个叶间及胸腔积液,4个局部气肿及肺大泡,3个叶间裂肥厚,8个肺实质炎症);CTPA发现亚段级肺动脉充盈缺损3个,6例假阴性病例均为多发亚肺段肺栓塞。结论 V/Q联合肺灌注SPECT/CT融合断层显像与CTPA诊断肺栓塞的效能相近,两者均有较好的诊断效能,前者对亚肺段水平肺栓塞的诊断有优势,且能排除由于其他肺部病变导致的假阳性诊断,提供肺部疾病额外诊断信息。
Objective To compare the diagnostic value of ventilation/perfusion(V/Q) combined with pulmonary perfusion single photon emission computed tomography combined with CT(SPECT/CT) fusion tomography imaging and computed tomographic pulmonary angiography(CTPA) in evaluation of pulmonary embolism. Methods We retrospectively analyzed 60 patients with clinically suspected pulmonary embolism diagnosed in Shanxi Dayi Hospital from May 2015 to May 2017. All patients underwent pulmonary V/Q imaging and lung perfusion SPECT/CT fusion tomography,and CTPA inspections were completed within 3 days. The final clinical diagnosis and follow-up confirmed the presence or absence of pulmonary embolism. The diagnostic efficacy of two imaging methods for pulmonary embolism were calculated and compared.Results Of the 60 cases of patients,33 cases were diagnosed with pulmonary embolism; the sensitivity,specificity,and accuracy of V/Q combined with pulmonary perfusion SPECT/CT fusion tomography were96. 97%(32/33),92. 59%(25/27) and 95%(57/60),respectively; the sensitivity,specificity,and accuracy of CTPA were 81. 82%(27/33),92. 59%(25/27) and 86. 67%(52/60),respectively; both have no diagnostic uncertainty,there was no significant difference in the qualitative diagnosis of pulmonary embolism between the two examination methods(P > 0. 05). V/Q combined with pulmonary perfusion SPECT/CT fusion tomography found 253 lung segment and 50 unmatched sub-pulmonary segments,including 15 V/Q mismatch lung segment and 5 sub-segment caused by lung lesions which were confirmed by lung perfusion SPECT/CT fusion image(5 interlobular or pleural effusion,4 local emphysema and pulmonary bulla,3 interlobular hypertrophy,8 pulmonary parenchymal inflammation); CTPA found 3 sub-segmental pulmonary filling defects,6 cases of false-negative cases were multiple sub-pulmonary segment pulmonary embolism. Conclusions V/Q combined with pulmonary perfusion SPECT/CT fusion tomography is similar to CTPA in diagnosing pulmonary embolism,and both of them have better diagnostic efficacy; the former has advantages in the diagnosis of sub-pulmonary segment pulmonary embolism,and can exclude false-positive diagnoses due to other lung lesions and provide additional diagnostic information for lung disease.
Objective To compare the diagnostic value of ventilation/perfusion(V/Q) combined with pulmonary perfusion single photon emission computed tomography combined with CT(SPECT/CT) fusion tomography imaging and computed tomographic pulmonary angiography(CTPA) in evaluation of pulmonary embolism. Methods We retrospectively analyzed 60 patients with clinically suspected pulmonary embolism diagnosed in Shanxi Dayi Hospital from May 2015 to May 2017. All patients underwent pulmonary V/Q imaging and lung perfusion SPECT/CT fusion tomography,and CTPA inspections were completed within 3 days. The final clinical diagnosis and follow-up confirmed the presence or absence of pulmonary embolism. The diagnostic efficacy of two imaging methods for pulmonary embolism were calculated and compared.Results Of the 60 cases of patients,33 cases were diagnosed with pulmonary embolism; the sensitivity,specificity,and accuracy of V/Q combined with pulmonary perfusion SPECT/CT fusion tomography were96. 97%(32/33),92. 59%(25/27) and 95%(57/60),respectively; the sensitivity,specificity,and accuracy of CTPA were 81. 82%(27/33),92. 59%(25/27) and 86. 67%(52/60),respectively; both have no diagnostic uncertainty,there was no significant difference in the qualitative diagnosis of pulmonary embolism between the two examination methods(P > 0. 05). V/Q combined with pulmonary perfusion SPECT/CT fusion tomography found 253 lung segment and 50 unmatched sub-pulmonary segments,including 15 V/Q mismatch lung segment and 5 sub-segment caused by lung lesions which were confirmed by lung perfusion SPECT/CT fusion image(5 interlobular or pleural effusion,4 local emphysema and pulmonary bulla,3 interlobular hypertrophy,8 pulmonary parenchymal inflammation); CTPA found 3 sub-segmental pulmonary filling defects,6 cases of false-negative cases were multiple sub-pulmonary segment pulmonary embolism. Conclusions V/Q combined with pulmonary perfusion SPECT/CT fusion tomography is similar to CTPA in diagnosing pulmonary embolism,and both of them have better diagnostic efficacy; the former has advantages in the diagnosis of sub-pulmonary segment pulmonary embolism,and can exclude false-positive diagnoses due to other lung lesions and provide additional diagnostic information for lung disease.
引文
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[10]刘纯宝.SP ECT和SP ECT/CT肺通气/灌注显像[J].中华核医学与分子影像杂志,2017,37(10):664-670.DOI:10.2967/jnumed.113.124602.
[11]李环,郑玉民,何嘉,等.肺通气/灌注断层显像和血浆D-二聚体检测对肺栓塞低度可能性患者诊断价值的对比研究[J].中华核医学与分子影像杂志,2014,31(6):449-452.DOI:10.3760/cma.j.issn.2095-2848.2014.06.007.
[12]苏剑,程勇,李芳,等.64层CT血管成像与肺通气灌注显像诊断肺栓塞的对比研究[J].医学影像学杂志,2011,21(1):37-39.DOI:10.3969/j.issn.1006-9011.2011.01.015.
[13]吴大勇,张文艳,邱刚,等.肺灌注SPECT/CT显像对可疑肺栓塞患者的诊断价值[J].广东医学,2014,35(9):1366-1368.
[14]张玥,刘玉婷,金刚,等.SPECT肺灌注/低剂量CT融合显像技术在肺栓塞中的诊断价值[J].标记免疫分析与临床,2016,23(4):375-378.DOI:10.11748/bjmy.issn.1006-1703.2016.04.006.
[15]Gutte H,Mortensen J,Jensen CV,et al.Detection of pulmonary embolism with combined ventilation-perfusion SPECT and low-dose CT:head-to-head comparision with multidetector CT angiography[J].J Nucl Med,2009,50(12):1987-1992.DOI:10.2967/jnumed.108.061606.
[16]梁田,刘会,谢晟,等.肺动脉CTA漏诊亚段肺栓塞原因分析[J].中国医学影像技术,2018,34(8):1220-1223.DOI:10.13929/j.1003-3289.201712033.
[17]Einstein AJ,Henzlova MJ,Rajagopalan S.Estimating risk of cancer associated with radiation exposure from 64-slice computed tomography coronary angiography[J].JAMA,2007,298(3):317-323.DOI:10.1001/jama.298.3.317.
[2]陈聪霞,姚稚明,郭悦,等.肺通气/灌注显像对老年急性肺栓塞的诊断价值[J].中华核医学与分子影像杂志,2014,34(4):301-304.DOI:10.3760/cma.j.issn.2095-2848.2014.04.008.
[3]Saar JA,Maack C.Diagnosis and management of acute pulmonary embolism.ESC guidelines 2014[J].Herz,2015,40(8):1048-1054.DOI:10.1007/s00059-015-4378-0.
[4]曾秋,赵渝,冯江毅,等.CT肺血管造影评价不同下肢深静脉血栓与肺栓塞关系[J].中国医师杂志,2014,16(3):306-309.DOI:10.3760/cma.j.issn.1008-1372.2014.03.007.
[5]王铁,杨媛华,张镭,等.肺灌注断层显像与平面显像在肺栓塞诊断中的比较[J].首都医科大学学报,2008,29(1):3-7.DOI:10.3969/j.issn.1006-7795.2008.01.002.
[6]邵国强,赵美丽,邵宏涛,等.肺灌注SPECT-CT显像对肺栓塞诊断和早期疗效评价的应用价值研究[J].标记免疫分析与临床,2015,22(11):1090-1094.DOI:10.11748/bjmy.issn.1006-1703.2015.11.006.
[7]韩洁,孟晶晶,米宏志,等.肺通气/灌注SPECT显像对肺栓塞的诊断价值[J].中华核医学与分子影像杂志,2017,37(2):81-85.DOI:10.3760/cma.j.issn.2095-2848.2017.02.004.
[8]阚英,王国强,李春林,等.肺通气/灌注SPECT显像在急性肺栓塞诊断中临床应用进展[J].临床和实验医学杂志,2013,12(23):1926-1929.
[9]Sostman HD,Stein PD,Gottschalk A,et al.Acute pulmonary embolism:sensitivity and specificity of ventilation perfusion scintigraphy in PIOPEDⅡstudy[J].Radiology,2008,246(3):941-946.DOI:10.1148/radiol.2463070270.
[10]刘纯宝.SP ECT和SP ECT/CT肺通气/灌注显像[J].中华核医学与分子影像杂志,2017,37(10):664-670.DOI:10.2967/jnumed.113.124602.
[11]李环,郑玉民,何嘉,等.肺通气/灌注断层显像和血浆D-二聚体检测对肺栓塞低度可能性患者诊断价值的对比研究[J].中华核医学与分子影像杂志,2014,31(6):449-452.DOI:10.3760/cma.j.issn.2095-2848.2014.06.007.
[12]苏剑,程勇,李芳,等.64层CT血管成像与肺通气灌注显像诊断肺栓塞的对比研究[J].医学影像学杂志,2011,21(1):37-39.DOI:10.3969/j.issn.1006-9011.2011.01.015.
[13]吴大勇,张文艳,邱刚,等.肺灌注SPECT/CT显像对可疑肺栓塞患者的诊断价值[J].广东医学,2014,35(9):1366-1368.
[14]张玥,刘玉婷,金刚,等.SPECT肺灌注/低剂量CT融合显像技术在肺栓塞中的诊断价值[J].标记免疫分析与临床,2016,23(4):375-378.DOI:10.11748/bjmy.issn.1006-1703.2016.04.006.
[15]Gutte H,Mortensen J,Jensen CV,et al.Detection of pulmonary embolism with combined ventilation-perfusion SPECT and low-dose CT:head-to-head comparision with multidetector CT angiography[J].J Nucl Med,2009,50(12):1987-1992.DOI:10.2967/jnumed.108.061606.
[16]梁田,刘会,谢晟,等.肺动脉CTA漏诊亚段肺栓塞原因分析[J].中国医学影像技术,2018,34(8):1220-1223.DOI:10.13929/j.1003-3289.201712033.
[17]Einstein AJ,Henzlova MJ,Rajagopalan S.Estimating risk of cancer associated with radiation exposure from 64-slice computed tomography coronary angiography[J].JAMA,2007,298(3):317-323.DOI:10.1001/jama.298.3.317.
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