肺灌注/通气显像与肺动脉造影诊断肺动脉栓塞的对比研究

A comparative analysis of pulmonary ventilation perfusion imaging with pulmonary angiography in the diagnosis of pulmonary embolism

目的 评价核素肺通气 /灌注 (V/Q)显像在肺动脉栓塞 (PE)诊断中的价值。方法 临床疑有PE患者 30例 ,男女各 15例 ,平均年龄 (38.2± 13.9)岁。均行胸部X线片检查、核素V/Q显像和肺动脉造影。 11例患者在行肺灌注显像时 ,选择双侧足背静脉注射肺灌注显像剂 ,同时完成双下肢静脉显像。结果 30例患者中 2 2例V/Q显像示不相匹配的肺叶、肺段或多发亚肺段的放射性分布稀疏或缺损 ,提示为PE ;但肺动脉造影证实 2 2例中 2 0例为PE。 8例患者的V/Q显像为相匹配的肺叶、肺段或多发亚肺段的稀疏或缺损 ,提示不是PE ,与肺动脉造影结果一致。核素V/Q显像诊断PE的灵敏度为 10 0 % (2 0 / 2 0例 ) ,特异性为 80 .0 % (8/ 10例 ) ,准确性为 93.3% (2 8/ 30例 )。X线胸片和核素下肢静脉显像有助于PE的正确诊断。结论 多数PE患者通过核素肺V/Q显像结合X线胸片可以作出明确诊断 。

Objective To assess the value of ventilation perfusion imaging in the diagnosis of pulmonary embolism(PE). Methods Thirty consecutive patients with clinically suspected pulmonary embolism were studied,male∶female=l5∶15, mean age was (38.2±13.9) years. The chest radiograms were obtained in all 30 patients. All patients underwent radionuclide ventilation perfusion imaging and pulmonary angiography. Results Of the 30 patients, 22 with lobe,multiple segment or miltisubsegment perfusion defects and normal or nearly normal ventilation images were reported as PE. 20 of them were confirmed to be with PE by pulmonary angiography, 2 patients were not confirmed. Eight of 30 patients with multiple perfusion defects, ventilative abnormalities were reported as non PE and the diagnoses were confirmed by pulmonary angiography. The sensitivity,specificity and accuracy of diagnosis of PE by ventilation perfusion imaging was 100%,80.0% and 93.3% respectively. Conclusions (1) Ventilation perfusion imaging is one of the most valuable methods in the diagnosis of PE. (2) The results suggest that pulmonary embolism can be diagnosed non invasively in most patients on the basis of clinical manifestation,chest radiograms and ventilation perfusion imaging findings. (3) Pulmonary angiography is required while clinical manifestation and ventilation perfusion imaging findings are discordant with each other.