SPECT V/Q断层显像半定量分析联合测定血浆D-二聚体诊断肺栓塞的价值

The Evaluation of Pulmonary Embolism Diagnosis Using SPECT V/Q Imaging Combined with D-Dimer Assay

研究V/Q断层显像半定量分析联合测定血浆D-二聚体早期、准确诊断肺栓塞的价值,尤其在小面积肺栓塞诊断中的应用优势。疑诊肺栓塞来核医学科行V/Q断层显像患者共156例,以CT肺血管造影(computed tomographic pulmonary angiography,CTPA)检查及临床诊断为分组标准,肺栓塞组患者101例,非肺栓塞组患者55例。比较SPECT V/Q断层显像、血浆D-二聚体测定以及SPECT V/Q断层显像联合血浆D-二聚体测定三种方法对肺栓塞的诊断效能。应用Philips公司Oasis图像后处理软件对栓塞面积进行半定量分析,进一步评估对于肺栓塞面积占双肺容积≤15%的小面积肺栓塞的诊断价值。结果显示,血浆D-二聚体测定对于肺栓塞的诊断有较高的灵敏度(70.3%),但是特异性(61.8%)差;SPECT V/Q断层显像半定量分析对于肺栓塞的诊断具有较高的灵敏度和特异性,分别为85.1%、90.9%;而二者联合应用,诊断肺栓塞效能最高,灵敏度和特异性分别为91.1%、98.2%。其中SPECT V/Q断层显像半定量分析对于肺栓塞面积小于15%的小面积肺栓塞诊断有优势。放射性核素SPECT V/Q断层显像联合测定血浆D-二聚体能显著提高肺栓塞的诊断效能,是临床实用、安全有效的肺栓塞疑诊患者诊断策略。

To evaluate the early and accurate diagnostic value of SPECT V/Q imaging combined with D-dimer assay, especially in non massive pulmonary embolism group. 156 patients with computed tomographic pulmonary angiography （CTPA）, Geneva score, response of anticoagulation treatments, who was selected from 321 patients with clini-cally suspected pulmonary embolism （PE） referred to the Nuclear Medicine Department of Beijing Anzhen Hospital from January to July 2014, were enrolled in the study. The patients were divided into PE group （n= 101） and non PE group （n= 55）. We compared the diagnostic performance of SPECT V /Q , D-dimer and SPECT V/Q combined with D-dimer measurement. The SPECT V/Q images were reconstructed by Oasis of Philips and interpreted by the attending nuclear physician using a diagnostic cut-off of one segmental or two subsegmental mismatches. D-dimer had good sensitivity of 70. 3 % and bad specificity of 61. 8% in the 156 patients. SPECT V/Q had good performance both sensitivity （85.1%） and specificity （90.9%）. But when SPECT V/Q combined with D-dimer, there were best diagnostic sensitivity （91. 1%） and specificity （98. 2%） in PE detection, especially in embolization extent less than 15%. SPECT V/Q combined with D-dimer measurement are effective and safe diagnostic management.