肺通气/灌注单光子发射计算机断层和低剂量CT融合显像在老年人肺栓塞中的诊断价值

Value of pulmonary ventilation/perfusion single-photon emission computed tomography and CT imaging in the diagnosis of pulmonary embolism in elderly patients

目的研究肺通气/灌注单光子发射计算机断层(SPECT)和低剂量CT融合显像(SPECT/CT)在老年人肺栓塞中的诊断价值。方法回顾性收集北京医院2015年1月至2019年12月临床疑诊肺栓塞并完成肺通气/灌注SPECT/CT检查的279例患者资料,其中年龄≥65岁者163例(老年组)、年龄<65岁者116例(非老年组)。以经随访证实正确的出院诊断为最终诊断,比较分析两个年龄组肺通气/灌注SPECT/CT的诊断效能,以及老年组肺通气/灌注SPECT/CT和经年龄校正的D-二聚体的诊断效能。老年组同期完成肺通气/灌注SPECT/CT、CT肺动脉造影(CTPA)者43例,比较分析其肺通气/灌注SPECT/CT与CTPA的诊断效能。结果老年组肺通气/灌注SPECT/CT诊断的敏感性、特异性与准确性分别为96.10%(74/77)、91.86%(79/86)和93.87%(153/163),与非老年组的诊断敏感性96.43%(27/28)、特异性94.31%(83/88)和准确性94.83%(110/116)比较差异均无统计学意义(χ^(2)=0.000、0.409、0.116,P=1.000、0.522、0.733)。经年龄校正的D-二聚体诊断的敏感性、特异性及准确性分别为84.42%(65/77)、63.95%(55/86)和73.62%(120/163),与肺通气/灌注SPECT/CT比较差异均有统计学意义(均P<0.05)。43例均行肺通气/灌注SPECT/CT及CTPA的老年患者中排除1例CTPA诊断不能确定者,肺通气/灌注SPECT/CT诊断敏感性、特异性、准确性分别为96.55%(28/29)、92.31%(12/13)、95.24%(40/42),CTPA的诊断敏感性、特异性与准确性分别为65.52%(19/29)、92.31%(12/13)、73.81%(31/42),两者特异性相同,敏感性和准确性差异有统计学意义(P=0.012、0.022)。结论肺通气/灌注SPECT/CT显像在老年患者中诊断肺栓塞的准确性高,优于CTPA和经年龄校正的D-二聚体。

Objective To study the value of ventilation/perfusion single-photon emission computed tomography(SPECT)in combination with a low-dose CT scan(SPECT/CT)in diagnosing pulmonary embolism(PE)in elderly patients.Methods In this retrospective study,data were collected from 279 patients with suspected PE and undergone SPECT/CT between January 2015 and December 2019 at Beijing Hospital,with 163 aged≥65(the elderly group)and 116 aged<65(the control group).Based on diagnosis confirmed during follow-up as the final diagnosis,the diagnostic efficacy of ventilation/perfusion SPECT/CT in the two age groups was examined.The diagnostic efficacy of ventilation/perfusion SPECT/CT and age-adjusted D-dimer in the elderly group was also compared.The diagnostic efficacy of ventilation/perfusion SPECT/CT and CT pulmonary angiography(CTPA)was compared in 43 elderly patients who had undergone both ventilation/perfusion SPECT/CT and CTPA.Results The sensitivity,specificity and accuracy of ventilation/perfusion SPECT/CT in the elderly group were 96.10%(74/77),91.86%(79/86)and 93.87%(153/163)in the elderly group and 96.43%(27/28),94.31%(83/88)and 94.83%(110/116)in the control group,respectively,with no statistically significant difference between the two groups(χ^(2)=0.000,0.409,0.116,P=1.000,0.522,0.733).The sensitivity,specificity and accuracy of age-adjusted D-dimer were 84.42%(65/77),63.95%(55/86)and 73.62%(120/163),and were significantly different from those of ventilation/perfusion SPECT/CT(all P<0.05).Among 43 elderly patients undergone ventilation/perfusion SPECT/CT and CTPA,1 was excluded because the diagnosis based on CTPA was uncertain.The diagnostic sensitivity,specificity and accuracy of ventilation/perfusion SPECT/CT were 96.55%(28/29),92.31%(12/13)and 95.24%(40/42)and those of CTPA were 65.52%(19/29),92.31%(12/13)and 73.81%(31/42).They had the same specificity,but there were significant differences in sensitivity and accuracy(P=0.012,0.022).Conclusions Ventilation/perfusion SPECT/CT has higher accuracy in the diagnosis of PE in elderly patients,compared with CTPA and age-adjusted D-dimer.