肺通气／灌注显像与多层螺旋CT诊断慢性血栓栓塞性肺动脉高压的对比研究

A comparison between ventilation/perfusion scintigraphy and multislice spiral CT in the diagnosis of chronic thromboembolic pulmonary hypertension

目的对比肺通气／灌注（V／Q）显像与多层螺旋CT肺血管造影（CTPA）诊断慢性血栓栓塞性肺动脉高压（CTEPH）的准确性，评价2种影像学方法的诊断符合程度。方法49例肺动脉高压患者，经超声心动图排除瓣膜性心脏病和先天性心脏病，既往无急性肺栓塞病史。所有患者先后行肺V／Q显像和CTPA检查，并以肺动脉造影为“金标准”进行对比评价。对V／Q显像和CTPA检查结果比较进行χ^2检验，采用SPSS12．0统计软件。结果肺V／Q显像对CTEPH的诊断灵敏度、特异性和准确性分别为100．0％（17／17），71．9％（23／32）和81．6％（40／49），CTPA分别为94．1％（16／17），81．2％（26／32）和85．7％（42／49）。肺V／P显像与CTPA的诊断符合率为75．5％（37／49），Kappa值为0．513，2种影像学方法的诊断结果差异无统计学意义（χ^2=0．75，P〉0．05）。结论肺V／Q显像和CTPA均是诊断CTEPH有效的无创性影像学方法，两者结合应用有助于更好地诊断CTEPH。

Objective Chronic thromboembolic pulmonary, hypertension （CTEPH） is one of the important causes of puhnonary hypertension with poor prognosis. Several imaging techniques had been used to identify CTEPH. The aim of this study was to assess the reliability of ventilation/perfusion （V/Q） scintigraphy and muhislice spiral CT pulmonary angiography （CTPA） in the diagnosis of chronic thromboembolic pulmonary hypertension, and the concordance rate （or ＂ agreement＂ as in the original article） between the two techniques. Methods Forty-nine in-patients with pulmonary hypertension without history of congenital heart disease, valvular heart disease and acute pulmonary embolism were included in this study. All these patients underwent V/Q scintigraphy as well as CTPA for detecting CTEPH. The final diagnosis was confirmed by pulmonary angiograpy. The results of V/Q seintigraphy and CTPA were compared with the χ^2 test. Results The sensitivity, specificity and accuracy of V/Q scinfigraphy in diagnosis of CTEPH was 100.0% （17/17）, 71.9% （23/32） and 81.6% （40/49）, respectively, and those of CTPA was 94. 1% （ 16/17）, 81.2% （26/32） and 85.7% （42/49）, respectively. The concordance rate was 75.5% （37/49, Kappa = 0. 513 ）, no statistically significant difference （χ^2 = 0. 75, P 〉 0. 05 ） was found between V/Q scintigraphy and CTPA. Conclusion Both V/Q scintigraphy and CTPA are reliable to diagnose CTEPH.