【摘要】 目的应用核素一日法肺通气/灌注(V/Q)显像研究下肢深静脉血栓(DVT)和肾静脉血栓(RVT)患者肺血栓栓塞症(PTE)的发病情况,并与CT血管造影(CTA)结果进行比较。方法99例DVT和RVT患者进行肺通气(锝气体)/锝标记大颗粒聚合人血清白蛋白(99mTc-MAA)灌注显像和胸部X线片检查,其中12例进行V/Q平面和单光子发射计算机断层扫描(SPECT)显像,23例同期进行CTA检查。根据肺栓塞前瞻性研究(PIOPED)诊断标准(1995年修订版),综合分析V/Q显像和胸部X线片结果,将PTE划分为高、中、低、极低度可能性和正常5类,并以高、中、低度可能性为阳性,极低度可能性和正常为阴性。比较灌注相SPECT显像与V/Q平面显像发现的病灶数量。结果99例患者中,PTE高度可能性为35.4%(35/99)、中度可能性为8.1%(8/99)、低度可能性为9.1%(9/99)、极低度可能性为4.0%(4/99)、正常为43.4%(43/99),阳性率为50.5%、阴性率为49.5%。12例同时进行CTA、肺灌注V/Q平面显像和SPECT显像检查的患者,3种检查分别发现48、43和50个阳性肺段。8例CTA检查阳性患者的48个受累肺段中,肺灌注V/Q平面显像显示34个肺段阳性,与CTA检查的符合率为70.8%;肺灌注SPECT显像显示39个肺段阳性,与CTA检查的符合率为81.2%;两种检查与CTA检查符合率间的差异有统计学意义(χ2=5.04,P<0.05)。肺灌注V/Q平面和SPECT显像分别较CTA检查多发现9个和11个病变肺段,均在亚肺段水平。肺灌注SPECT显像较V/Q平面显像多发现的7个肺段也均定位于亚肺段水平。肺动脉部分栓塞时,由于血流可以通过,肺组织灌注可能正常,V/Q显像往往不能发现病变血管;而当外周肺段、亚肺段较小肺动脉栓塞时,CTA检查易漏诊。结论SPECT可以明显改进肺V/Q显像。肺V/Q显像可以提供优良、准确的PTE诊断结果,CTA检查与其可优势互补。更多还原

【Abstract】 Objective To assess the application of lung ventilation/perfusion(V/Q) scan in examining pulmonary thromboembolism(PTE) in patients with deep venous thrombosis(DVT) or renal venous thrombosis(RVT),and to compare the result with that of CT angiography(CTA).Methods A total of 99 patients with DVT or RVT underwent V/Q planar scan and chest X-ray.The modified Prospective Investigation of Pulmonary Embolism Diagnosis(PIOPED) criterion was used for interpretation of lung scintigraphy.Twelve patients also received V/Q single photon emission computed tomography(SPECT)/CT;twenty-three patients underwent CTA.The risks of PTE were divided into high,moderate,low,very low grades and normal.The high,moderate,and low risks were taken as positive;the very low risk and normal were taken as negative.The lesion numbers by detected SPECT and V/Q were compared.Results In 99 patients,35.4%(35/99) were found at high risk of PTE by lung V/Q scan;8.1%(8/99) and 9.1%(9/99) were found at moderate and low risks,respectively.Compared with planar scintigraphy,SPECT detected more defects at the segmental and subsegmental level(10/53).In 12 patient underwent both lung V/Q scan and CTA,the abnormal segments detected by CTA were 48,by planar and SPECT-CT pulmonary imaging were 43 and 50,respectively.Among the 8 patients with positive CTA results,the coincident rate between CTA and planar pulmonary imaging was 70.8%.In pulmonary SPECT-CT imaging,the abnormal segments were detected with a coincident rate of 81.2%.The coincident rates between the two methods with CTA were significantly different(χ2=5.04,P<0.05).P.sxlanar and SPECT-CT imaging detected 9 more and 11 more lesions than CTA did at the subsegmental level.Also,SPECT-CT imaging found 7 more defects than planar imaging did at the subsegmental level.Conclusion SPECT can substantially improve the V/Q image of lung.V/Q scintigrphy can provide excellent,accurate PTE diagnosis results;it can complement with CTA.更多还原