不同临床评分中肺通气灌注显像与CT肺动脉造影诊断肺栓塞对比研究

The comparative study on different clinical scoring of lung ventilation perfusion imaging and CTPA in the diagnosis of pulmonary embolism

目的分析肺通气/灌注(V/Q)显像和肺CT肺动脉造影(CTPA)对不同临床评分分组中疑似肺栓塞(PE)患者的诊断价值。方法将2006年3月至2009年11月,临床疑似PE同时接受了肺64层螺旋CTPA和V/Q显像的180例患者作为研究对象。对Wells临床评分分组的每组V/Q显像和多层螺旋肺CTPA造影两种检查方法的准确性、符合性及不确定性诊断比率的差异进行分析比较。结果 180例患者中Wells评分为低度可能组中CTPA和V/Q显像诊断PE的敏感性、特异性、符合率、分别为88%和82%,91%和90%,90%和88%。Wells评分为中度可能组中CTPA和V/Q显像诊断PE的敏感性、特异性、符合率、分别为88%和72%,91%和77%,90%和74%。Wells评分为高度可能组中CTPA和V/Q显像诊断PE的敏感性、特异性、符合率分别为94%和92%,90%和87%,91%和90%。结论 CTPA可作为临床中度疑诊PE病例的首选检查方法。而在Wells评分低度可能性及高度可能性组别中两者皆可作为确诊及排除疑诊肺栓塞病例的检查方法。

Objective To analyze the diagnostic significance of lung ventilation perfusion imaging and CT pulmonary angiography for different clinical scoring groups in patients with suspected pulmonary embolism.Methods From March 2006 to November 2009,180 cases of clinical suspected pulmonary embolism who received 64-slice CT pulmonary angiography and lung ventilation/perfusion imaging were enrolled in the study.The diagnostic accuracy,correspondence,uncertainty in Wells clinical scores grouping by the two examination methods were analyzed and compared.Results Among 180 patients whose Wells scoring was unlidely,the PE sensitivity and specificity,accuracy for CTPA and V/Q imaging diagnosis were 88% vs 82%,91% vs 90%,90% vs 88% respectively,which in midrange possible groups were 88% vs 72%,91% vs 77%,90% vs 74% respectively,which in highly possible groups were 94% vs 92%,90% vs 87%,91% vs 90% respectively.Conclusion CTPA can be used as the first choice method in the clinical diagnosis of pulmonary embolism moderate suspected cases,while in the cases with Wells scoring being unlidely and high possibility,and the two methods can be used as the examination methods that can confirm and eliminate suspected cases of pulmonary embolism.