急性肺动脉血栓栓塞症核素肺灌注显像与电子束计算机断层摄影术的对比研究

Comparison of Pulmonary Perfusion Imaging and Electron Beam Computed Tomography for Acute Pulmonary Embolism

目的通过对急性肺栓塞患者的核素肺灌注显像与电子束计算机断层摄影术(EBCT)的对比分析,初步探讨两者之间存在差异的原因和规律,以及肺动脉血管阻塞与血流灌注变化之间的对应关系。方法20例急性肺栓塞患者,24h内先后接受核素肺灌注显像和EBCT肺血管增强造影。逐个肺段对比EBCT所显示的肺动脉阻塞与肺灌注显像所显示的肺血流灌注的情况。结果多数(81.7%)肺动脉完全闭塞型病变对应相应肺段的灌注完全缺失,血流灌注分布与非完全闭塞型病变相比有显著性差异(P<0.01)。在非完全闭塞型病变中,多级肺动脉病变对应灌注完全缺失的比例较高(60.0%),多级肺动脉病变与单级肺动脉病变相比,血流灌注亦有明显的差异(P<0.05)。而不同类型的非完全闭塞型病变所对应的血流灌注没有明显差异(P>0.05)。结论不同形式的血管阻塞所造成的血流灌注变化的不同,是EBCT与肺灌注显像存在差别的主要原因之一,肺栓塞的血管阻塞和灌注受损是相互联系又有所不同的两个方面,肺灌注显像和EBCT结合应用能够使肺栓塞的诊断和疗效评价更加全面准确。

Objective ：To detect and to discuss the difference and reasons in diagnosis of acute pulmonary embolism by comparing pulmonary perfusion imaging with electron beam computed tomography （EBCT）. Methods：Twenty patients with confirmed acute pulmonary embolism underwent pulmonary perfusion imaging and EBCT successively. Correlation analysis between emboli obstruction and pulmonary perfusion was performed on segment-by-segment basis. Results：Most of complete pulmonary arterial occlusion （81.7%） and most of multi-level incomplete arterial occlusions （60.0%） shown by EBCT generally corresponded to perfusion defects in pulmonary perfusion imaging. A significant difference of pulmonary perfusion was found between those pulmonary segments with complete and incomplete arterial occlusions （P〈0.01） , and multi-level arterial and single-level incomplete occlusions （P〈0.05）. No difference of perfusion was found between each style of incomplete arterial occlusions （P〉0.05）. Conclusion ：The pulmonary arterial occlusions with different severities and extents corresponded to difference of pulmonary perfusion, which was one of the most important reasons for the differences between EBCT and pulmonary perfusion imaging in estimating acute pulmonary embolism. It is helpful to combine EBCT and pulmonary perfusion imaging for diagnosis of acute pulmonary embolism.