核素肺灌注断层显像结合同机CT平扫在恶性肿瘤患者肺栓塞中的诊断价值

Study of combined pulmonary perfusion tomography scintigraphy and CT in diagnosis of pulmonary embolism in patients with malignant tumor

目的评价核素肺灌注断层显像结合同机CT平扫(Q-SPECT/CT)在诊断恶性肿瘤患者肺栓塞(PE)方面的临床应用价值。方法 50例临床疑诊肺栓塞的恶性肿瘤患者同日行Q-SPECT/CT及核素肺通气/灌注平面显像(V/Q),比较2种显像方式对该类患者的诊断效能。结果 34例患者最终诊断为肺栓塞;Q-SPECT/CT显像诊断的灵敏度、特异性、准确性分别为91%、88%及90%,V/Q平面显像诊断的灵敏度、特异性、准确性分别为82%、81%及82%,Q-SPECT/CT显像灵敏度、特异性及准确性高于平面显像(P<0.05);Q-SPECT/CT显像诊断肺段病变68个、亚肺段病变89个,V/Q平面显像诊断肺段病变66个、亚肺段病变81个,Q-SPECT/CT显像检出的亚肺段病变明显多于平面显像(P<0.05)。结论 Q-SPECT/CT显像比V/Q平面显像诊断肺栓塞的灵敏度高,能检出更多的亚肺段病变,尤其对于不能有效行肺通气显像的患者具有重要临床应用价值。

Objective To evaluate the clinical application value of combined pulmonary perfusion tomography scintigraphy and CT （Q-SPECT/CT） in diagnosis of pulmonary embolism （PE） in patients with malignant tumor. Methods Fifty malignant tumor patients suspected with PE were performed Q-SPECT/CT and pulmonary ventilation/ perfusion planer imaging （V/Q）in the same day. The diagnostic efficiency between Q-SPECT/CT and planer V/Q imaging were compared. Results Thirty-four patients were finally diagnosed with PE. The sensitivity, specificity and accuracy of Q-SPECT/CT were 91%,88% and 90% respectively. On other hand, the sensitivity, specificity and accu- racy of planer V/Q imaging were 82%,81% and 82% respectively. Q-SPECT/CT in diagnosis sensitivity, specificity and accuracy was superior to planar imaging （P〈0.05）. The number of affected pulmonary segment and subsegment detected by Q-SPECT/CT were sixty-eight and eighty-nine severally. The number of affected pulmonary segment and subsegment detected by planer V/Q planar imaging were sixty-six and eighty-one severally. The affected pulmonary subsegment number detected by Q-SPECT/CT was higher than that detected by planer imaging （P〈0.05）. Conclusion Q-SPECT/CT scan can provide better sensitivity and detect more affected pulmonary subsegment, and it＇s very impor- tant to that patients who can not perform pulmonary ventilation imaging efficiently.