肺通气/灌注显像诊断不典型亚肺段肺栓塞

Diagnosis of atypical subsegmental pulmonary embolism using pulmonary ventilation/perfusion ima- ging

目的评价核素肺通气/灌注(V/Q)显像对不典型亚肺段肺栓塞(PE)的诊断价值。方法患者141例,男58例,女83例,年龄(65.67±11.29)岁,其中下肢静脉病变史者14例,糖尿病、高脂血症史者45例,63例近期内行有创性诊断和治疗,另19例均无上述病史或诊疗史。所有患者行常规^(99)Tc^m-MAA 和^(99)Tc^m 气体显像后进行1～24个月的抗凝治疗,于治疗后再行肺灌注显像。将抗凝治疗前后肺灌注显像进行对比分析,根据肺内放射性分布的变化判断治疗效果,再结合临床资料及其他影像检查综合判断不典型 PE 的诊断。结果 141例患者肺灌注显像均显示某个肺野内不呈肺段或亚肺段分布的片状或小斑片状放射性分布稀疏区。肺通气显像示肺野内放射性分布基本均匀,未见放射性分布稀疏区。治疗后118例肺灌注显像显示双肺内放射性分布不同程度的增多或均匀。按肺野内放射性分布改善情况标准评价:抗凝治疗后恢复正常35例,显效49例,有效34例,总有效率为83.69%(118/141)。另23例肺内放射性分布无明显变化,视为无效。结论 V/Q 显像是诊断不典型亚肺段 PE 的首选方法。

Objective Pulmonary ventilation/perfusion （V/Q） imaging was used in the diagnosis of atypical subsegmental pulmonary embolism（PE） and monitoring the response to anti-coagulation. Methods A total of 141 patients （58 men, 83 women, 40 - 83 years） underwent ^99Tc^m-MAA and ^99Tc^m-Technegas pulmonary V/Q imaging, and then underwent pulmonary perfusion imaing after 1 - 24 months oral anticoagulative therapy. Fourteen cases had lower limbs venous lesions, 45 diabetes mellitus or hyperlipaemia, and 63 the history of invasive diagnosis or therapy management recently. Pre- and post-anticoagulation images were compared and combined with clinical information and other imaging modalities to assess the subsegmental PE. Results All pulmonary perfusion images showed defects in different sizes with normal pulmonary ventilation images. After therapy, the radioactive uptake and distribution in both lungs improved in 118/141 （83.69%） cases. The post-treatment scans were judged normal in 35 patients, obviously improved in 49, mildly improved in 34. Conclusion Pulmonary V/Q imaging provided accurate information in both diagnosis and post-therapy monitoring of atypical subsegmental PE.