对比肺通气/灌注显像和CT肺动脉造影对急性肺栓塞患者发生慢性血栓栓塞性肺动脉高压的预测价值

Compare the value of ventilation/perfusion scanning and CT pulmonary angiography in predicting chronic thromboembolic pulmonary hypertension after acute pulmonary embolism

目的:比较肺通气/灌注(ventilation/perfusion,V/Q)显像和CT肺动脉造影(pulmonary angiography,PA)预测急性肺栓塞(acute pulmonary embolism,APE)后慢性血栓栓塞性肺动脉高压(chronic thromboembolic pulmonary hypertension,CTEPH)发生的价值。方法:回顾性收集了2012年1月至2020年8月,确诊为APE患者的资料,所有患者经至少3个月规范化抗凝后复查肺V/Q显像和CTPA。分别评估并计算肺V/Q显像和CTPA图像中的残余肺栓塞,并分别记录为肺灌注缺损百分比(percentage of pulmonary defect scores,PPDs%)和CT肺动脉阻塞指数(pulmonary artery obstruction index,PAOI)。评价PPDs%和CTPAOI预测CTEPH发生的一致性。绘制受试者工作特征(ROC)曲线,评估PPDs%和CTPAOI对APE后CTEPH发生的预测效能。结果:共纳入224例APE患者,1年内随访,共有26例进展为CTEPH。Bland-Altman图示两检查评估APE治疗后残余肺栓塞的一致性较好。ROC分析示PPDs%的AUC>CTPAOI(0.958 vs.0.868,P=0.03);预测CTEPH发生的阈值分别为20.5%和15.0%,相应的敏感性和特异性分别为92.3%、88.9%和76.9%、89.4%,差异均无统计学意义(敏感性:P=0.13;特异性:P>0.999)。结论:肺V/Q显像预测APE后CTEPH发生率比CT PA更敏感,但特异性略低。

Objective:To compare the value of lung ventilation/perfusion(V/Q)scanning and CT pulmonary angiography(PA)in predicting chronic thromboembolic pulmonary hypertension(CTEPH)development after acute pulmonary embolism(APE).Methods:From January 2012 to August 2020,patients with initial diagnosis of APE who undergone both lung V/Q and CTPA after 3-month anticoagulation were retrospected.The residual pulmonary obstructions were assessed and calculated based on V/Q and CTPA,then recorded as percentage of pulmonary defect scores(PPDs%)and CT pulmonary artery obstruction index(PAOI).The uniformity of PPDs%and CTPAOI in predicting CTEPH was evaluated.The predictive performance of PPDs%and CTPAOI for CTEPH development were determined by receiver operating characteristic(ROC)curves,and the areas under the curves(AUC)were calculated.Results:A total of 224 patients were enrolled.Within the 1-year follow-up,26 patients developed to CTEPH.Bland-Altman plot shows uniformity of residual pulmonary embolism between PPDs%and CTPAOI was better.ROC analysis showed that the AUC of the PPDs%were largerthan that of CTPAOI(0.958 vs.0.868,P=0.03),with corresponding cut-off values of 20.5%and 15.0%for predicting CTEPH development.Neither sensitivity nor specificity differed significantly between PPDs%and CTPAOI(Sensitivity:92.3%vs.88.9%,P=0.13;Specificity:76.9%vs.89.4%,P>0.999).Conclusions:V/Qscanning has a tendency to be more sensitive but less specific than CT PA in predicting CTEPH development.