肺通气灌注显像在定量评估哮喘患者肺功能中的应用

Application of V/P SPECT/CT in quantitative assessment of lung function in patients with asthma

目的探讨肺通气灌注显像(V/P SPECT/CT)在定量评估哮喘患者肺功能中的应用以及指导哮喘患者肺局部治疗的潜在价值。方法本研究共纳入20例哮喘患者。所有患者均行V/P SPECT/CT造影和肺通气功能检查,并采用哮喘控制测试(ACT)对患者进行症状评估。根据V/P SPECT/CT图像视觉评分标准,对患者的气道阻塞程度进行分级。并综合V/P显像中各个肺段的通气及灌注缺损情况,定量评估患者的肺通气灌注综合功能(%)。并分析由V/P SPECT/CT图像得到的气道阻塞程度和肺通气灌注综合功能结果,与传统肺通气功能指标和ACT评分之间的相关性。利用Q Lung软件定量分析各肺叶的肺功能和肺体积。结果V/P SPECT/CT显像可以对哮喘患者的气道阻塞程度进行分级(分为0~3级)。由V/P SPECT/CT视觉评分得出的气道阻塞分级结果与第1秒用力呼气容积占预计值百分比(FEV1%pred)之间具有相关性(r=–0.74,P<0.001)。V/P SPECT/CT还能综合评估哮喘患者的通气与灌注功能,且由该方法测得的哮喘患者肺通气灌注综合功能与FEV1%pred也具有相关性(r=0.629,P=0.003)。V/P SPECT/CT能够定量分析患者各肺叶的通气灌注功能百分比。当用普通CT所测的各肺叶体积来代替各肺叶功能占比时,与V/P SPECT/CT的结果相比,CT结果会高估上肺叶的贡献,而低估下叶对整体功能的贡献。结论V/P SPECT/CT可作为一种新的检测方法,能直观反映哮喘患者的气道阻塞程度,且能综合定量评估哮喘患者的通气灌注功能。V/P SPECT/CT还能用于评估哮喘患者肺叶局部功能,有助于发现哮喘患者肺内功能改变的异质性,对于未来针对肺特定部位的治疗具有潜在价值。

Objective To explore the application of pulmonary ventilation and perfusion imaging(V/P SPECT/CT)in quantitative evaluation of ventilation and perfusion function and its potential value in guiding local treatment of lung in patients with asthma.Methods A total of 20 patients with asthma were included in this study.All patients underwent V/P SPECT/CT and pulmonary function test,and symptoms were assessed by the ACT questionnaire.Patients were graded for degree of airway obstruction according to V/P SPECT/CT image visual scoring criteria.The comprehensive lung function(%)of the patients was quantitatively evaluated by combining the ventilation and perfusion defect of each lung segment in V/P imaging.The correlation between the degree of airway obstruction,comprehensive lung function,pulmonary function test and ACT score was analyzed.Results V/P SPECT/CT imaging can be used to grade the degree of airway obstruction in asthma patients(0-3 grade).Airway obstruction grading by V/P SPECT/CT visual score was associated with predictive forced expiratory volume in one second(FEV1%pred)of patients(r=–0.74,P<0.001).V/P SPECT/CT can also comprehensively evaluate ventilation and perfusion function in patients with asthma,and comprehensive lung function measured by this method was also correlated with FEV1%pred(r=0.629,P=0.003).V/P SPECT/CT can be used to quantitatively analyze the percentage of ventilation and perfusion function in each lung lobe.Compared with V/P SPECT/CT results,the CT volume overestimates the contribution in the upper lobes,and underestimates the lower lobes contribution to overall function.Conclusions V/P SPECT/CT can be used as a new method to directly reflect the degree of airway obstruction in patients with asthma.Moreover,it can comprehensively and quantitatively evaluate the ventilation and perfusion function of asthma patients.V/P SPECT/CT can also be used to evaluate lobe function in patients with asthma,helping to identify the heterogeneity of changes in pulmonary function in patients with asthma,and has potential value for future treatment targeting specific areas of the lung.