肺通气灌注联合肺灌注融合断层显像与CT肺动脉造影对肺栓塞诊断价值的比较

A comparison of ventilation perfusion combined with pulmonary perfusion fusion tomography imaging and CT pulmonary angiography for diagnosis of pulmonary embolism

目的比较肺通气/灌注(V/Q)联合肺灌注单光子发射计算机断层显像联合同机CT融合断层显像(SPECT/CT)与螺旋CT肺动脉造影(CTPA)对肺栓塞的诊断价值。方法回顾性分析山西大医院2015年5月至2017年5月诊治的临床疑似肺栓塞患者60例的临床资料,患者均行V/Q显像及肺灌注SPECT/CT显像,并于3 d内完成CTPA检查,以最终临床综合诊断及随访证实有无肺栓塞,分别计算并比较两种显像方法对肺栓塞的诊断效能。结果 60例患者中,33例诊断为肺栓塞;V/Q联合肺灌注SPECT/CT融合断层显像的灵敏度、特异度、准确性分别为96. 97%(32/33)、92. 59%(25/27)、95%(57/60);CTPA的灵敏度、特异度、准确性分别为81. 82%(27/33)、92. 59%(25/27)、86. 67%(52/60);两者均无不确定诊断,两种检查方法在定性诊断肺栓塞方面差异无统计学意义(P> 0. 05)。V/Q联合肺灌注SPECT/CT融合断层显像共发现通气灌注不匹配肺段253个,亚肺段50个,其中15个V/Q不匹配肺段及5个亚肺段经肺灌注SPECT/CT融合断层图像证实由肺部病变所致(5个叶间及胸腔积液,4个局部气肿及肺大泡,3个叶间裂肥厚,8个肺实质炎症);CTPA发现亚段级肺动脉充盈缺损3个,6例假阴性病例均为多发亚肺段肺栓塞。结论 V/Q联合肺灌注SPECT/CT融合断层显像与CTPA诊断肺栓塞的效能相近,两者均有较好的诊断效能,前者对亚肺段水平肺栓塞的诊断有优势,且能排除由于其他肺部病变导致的假阳性诊断,提供肺部疾病额外诊断信息。

Objective To compare the diagnostic value of ventilation/perfusion ( V/Q) combined with pulmonary perfusion single photon emission computed tomography combined with CT ( SPECT/CT) fusion tomography imaging and computed tomographic pulmonary angiography ( CTPA ) in evaluation of pulmonary embolism. Methods We retrospectively analyzed 60 patients with clinically suspected pulmonary embolism diagnosed in Shanxi Dayi Hospital from May 2015 to May 2017. All patients underwent pulmonary V/Q imaging and lung perfusion SPECT/CT fusion tomography, and CTPA inspections were completed within 3 days. The final clinical diagnosis and follow-up confirmed the presence or absence of pulmonary embolism. The diagnostic efficacy of two imaging methods for pulmonary embolism were calculated and compared. Results Of the 60 cases of patients, 33 cases were diagnosed with pulmonary embolism;the sensitivity, specificity, and accuracy of V/Q combined with pulmonary perfusion SPECT/CT fusion tomography were 96. 97%(32/33), 92. 59%( 25/27) and 95%(57/60), respectively;the sensitivity, specificity, and accuracy of CTPA were 81. 82%(27/33 ), 92. 59%(25/27) and 86. 67%(52/60), respectively;both have no diagnostic uncertainty, there was no significant difference in the qualitative diagnosis of pulmonary embolism between the two examination methods ( P〉0. 05 ). V/Q combined with pulmonary perfusion SPECT/CT fusion tomography found 253 lung segment and 50 unmatched sub-pulmonary segments, includ ing 15 V/Q mismatch lung segment and 5 sub-segment caused by lung lesions which were confirmed by lung perfusion SPECT/CT fusion image (5 interlobular or pleural effusion, 4 local emphysema and pulmonary bulla, 3 interlobular hypertrophy, 8 pulmonary parenchymal inflammation );CTPA found 3 sub-segmental pulmonary filling defects, 6 cases of false-negative cases were multiple sub-pulmonary segment pulmonary embolism. Conclusions V/Q combined with pulmonary perfusion SPECT/CT fusion tomography is similar to CTPA in diagnosing pulmonary embolism, and both of them have better diagnostic efficacy;the former has advantages in the diagnosis of sub-pulmonary segment pulmonary embolism, and can exclude false-positive diagnoses due to other lung lesions and provide additional diagnostic information for lung disease.