肺灌注SPECT/CT对不同Wells评分可疑肺栓塞的下肢深静脉血栓的诊断价值

Diagnostic value of pulmonary perfusion SPECT / CT for lower-limb deep-vein thrombosis cases of patient with suspected pulmonary embolism which had different Wells scores

目的探讨肺灌注SPECT/CT显像对不同Wells评分可疑肺栓塞的下肢深静脉血栓患者的诊断价值。方法选取行肺灌注SPECT/CT显像可疑肺栓塞的下肢深静脉血栓患者210例,根据《2008版欧洲急性肺栓塞诊断治疗指南》推荐的Wells评分标准进行评分,总分≥7分为高度危险,≥2分、<7分为中度危险,<2分为低度危险。根据评分分为高度危险组(n=89)、中度危险组(n=64)及低度危险组(n=57)。对患者肺灌注SPECT/CT图像回顾性分析,计算3组肺栓塞的阳性率,利用SPSS 17.0对3组数据进行行乘列表χ2检验。结果高度危险组阳性率为70.8%(63/89),中度危险组阳性率为29.7%(19/64),低度危险组阳性率为10.5%(6/57),3组阳性率差异有统计学意义(χ2=57.47,P<0.05)。结论可疑肺栓塞下肢深静脉血栓患者Wells评分为高度或中度危险时,推荐行肺灌注SPECT/CT检查明确是否存在肺栓塞,以指导进一步的临床决策。当Wells评分为低度危险时,可暂不进行肺灌注SPECT/CT检查。

Objective To explore the diagnostic value of pulmonary perfusion SPECT / CT for patients with lower-limb deep-vein thrombosis（ DVT） who may have pulmonary embolism（ PE） with different Wells scores. Methods The study included DVT patients（ n = 210） with suspected PE. According to the Wells scores recommended by the 2008 European Pulmonary Embolism Diagnosis Guideline,the patients were divided into the high risk group（ score ≥ 7,n = 89）,moderate risk group（2≤ score 7,n = 64） and lowrisk group（ score 2,n = 57）. The patients＇ pulmonary perfusion SPECT / CT images were retrospectively analyzed. The positive rates of the three groups were calculated.The data were analyzed with chi-square（ χ2）test. Results The positive rate of the high,moderate and lowrisk group was 70. 8%（63 /89）,29. 7%（19 /64） and 10. 5%（6 /57）,respectively. There were statistical differences among the groups（ χ2= 57. 47,P 0. 05）. Conclusion When DVT patients suspected of PE are diagnosed to have high risk or moderate risk by Wells scores,pulmonary perfusion SPECT / CT imaging should be recommended to confirm whether pulmonary embolism exists.