肺灌注显像结合X线胸片诊断急性肺栓塞

Diagnosis of acute pulmonary embolism by pulmonary perfusion imaging combined with chest X-ray

目的探讨肺灌注显像/X 线胸片检查(Q/X)替代肺灌注/通气显像(Q/V)用于急性肺栓塞诊断的可行性。方法 72例疑诊急性肺栓塞,且肺灌注显像显示至少有一个肺段灌注缺损的患者,24 h 内行 X 线胸片检查和肺通气显像,比较 Q/X 和Q/V 的诊断符合率和准确性。结果 Q/X与 Q/V 结果的符合率为84.7%,Q/X 对 Q/V 的阳性预测值为83.7%,阴性预测值为87.0%。在该组病例中,Q/X 诊断急性肺栓塞的灵敏度为94.9%,特异性为63.6%,准确性为80.6%;而 Q/V 则分别为94.9%,78.8%和87.5%。5例慢性阻塞性肺部疾病(COPD)Q/X 均显示不匹配,而Q/V 均显示匹配,两者结果不同。结论对于多数疑诊急性肺栓塞患者,Q/X 可以替代Q/V 用于诊断,但对于 COPD 患者应选择 Q/V。

Objective The aim of the study was to examine whether pulmonary perfusion imaging combined with chest X-ray （Q/X） could replace pulmonary perfusion/ventilation imaging. （Q/V） in the diagnosis of acute pulmonary embolism. Methods In 72 patients suspected of pulmonary embolism and with at least one segmental perfusion defect, the Q/X and Q/V were classified as mismatched or matched, and the agreement of Q/X with Q/V analyzed for the diagnosis of acute pulmonary embolism. Results Acute pulmonary embolism was diagnosed in 39 and excluded in 33 patients. The overall agreement between Q/X and Q/V was 84.7%. The positive predictive value of mismatched Q/V in case of a mismatched Q/X was 83.7% , and the negative predictive value of matched Q/V in case of a matched Q/X was 87.0%. The sensitivity, specificity and accuracy of Q/X were 94.9% , 63.6% and 80.6% , respectively, compared with 94.9% , 78.8% , and 87.5% of Q/v in all cases. Mismatched Q/X but matched Q/V was observed in 5 patients all with chronic obstructive pulmonary disease （COPD）. Conclusions In the majority of patients with suspected acute pulmonary embolism, Q/X could reliably replace Q/V. However, Q/V should be selected for the diagnosis of acute pulmonary embolism in those patients with COPD.