肺通气/灌注SPECT-CT融合显像在急性肺栓塞诊断中的应用价值研究

Effectiveness of Application of Lung Ventilation/Perfusion SPECT-CT Fusion Imaging in Diagnosis of Acute Pulmonary Embolism

目的探讨肺通气/灌注SPECT-CT融合显像（V/P-SPECT-CT）在急性肺栓塞（APE）的诊断和排除诊断中的应用价值。方法回顾性收集2012年1月-2015年1月临床可疑APE患者116例,均接受肺V/P显像（平面显像和SPECT-低剂量融合CT显像）,并在显像前/后2 d完成肺动脉CT造影（CTPA）检查,分析其在肺段、亚肺段APE病灶的诊断和排除诊断中的应用价值。结果 75例确诊APE患者（受损肺段和亚肺段分别为240个和62个）,肺V/P-SPECT-CT显像诊断APE的灵敏度、特异性、准确性、假阳性率、假阴性率分别为96.0%、92.7%、94.8%、7.3%和4.0%,特异性明显高于肺CTPA和肺P-SPECT-CT显像,假阳性率低于肺P-SPECT-CT显像,肺V/P-SPECT-CT显像可诊断出94.7%的APE病灶（肺段、亚肺段分别为235个和51个）,明显高于CTPA（68.2%,194和12个）。肺V/P-SPECT-CT显像排除诊断中确诊慢性肺部疾病26例（COPD 10例,肺占位3例,叶间裂、胸腔积液7例,肺炎、肺不张等6例）。结论肺V/P-SPECT-CT显像结合功能和解剖学影像信息,诊断APE特异性高、假阳性率低,且在排除诊断中对非APE给予疾病诊断,具有较好的应有优势。

Objective To investigate the effectiveness of pulmonary ventilation/perfusion SPECT （Single-Photon Emission Computed Tomography） combined with low-dose CT （V/P-SPECT-CT） imaging in diagnosis of APE （Acute Pulmonary Embolism）. Methods Medical imaging data of 116 suspected APE patients who were scanned by pulmonary V/P-SPECT-CT from January 2012 to January 2015 were retrospectively collected. CTPA （Computed Tomography Pulmonary Angiography） was performed in all the patients two days before/after V/P-SPECT-CT scanning so as to analyze the effectiveness of application of V/P-SPECT-CT in diagnosis and exclusive diagnosis of pulmonary segment and sub-segment APE lesions. Results Among 75 identiifed APE cases （240 affected pulmonary segments and 62 affected pulmonary sub-segments）, the diagnostic sensitivity, speciifcity, accuracy, false positive rate and false negative rate of V/P-SPECT-CT for APE were 96%, 92.7%, 94.8%, 7.3%and 4%, respectively. Its diagnostic speciifcity was higher than that of CTPA and pulmonary P-SPECT-CT. Its false positive rate was lower than that of pulmonary P-SPECT-CT. Altogether 94.7%of APE lesions （235 pulmonary segments and 51 pulmonary sub-segments） were displayed on V/P-SPECT-CT imaging, which was obviously higher than that of CTPA （68.2%, 194 segments and 12 subsegment）. In non-APE cases, 26 patients with chronic pulmonary diseases [including 10 with COPD （Chronic Obstructive Pulmonary Diseases）;3 with pulmonary space occupying;7 with pleural or encapsulated effusion;6 with pneumonia or pulmonary closure] were revealed on pulmonary V/P-SPECT-CT imaging. Conclusion In combination with functional and anatomical imaging information, pulmonary V/P-SPECT-CT fusion imaging proved its advantages of higher diagnostic speciifcity and lower false negative rate in diagnosis of APE and also could provide diagnosis for non-APE patients, which had great advantages in the application.