肺灌注/通气显像在肺动脉栓塞诊断中的价值

目的:评价核素肺通气/灌注(V/Q)显像在肺动脉栓塞(PE)诊断中的价值。方法:回顾总结40例核素肺灌注/通气显像与肺动脉造影(CPA)诊断PE的对照研究。结果:31例患者V/Q显像示不相匹配的肺叶、肺段或多发亚肺段的放射性分布稀疏或缺损,提示为PE,其中肺动脉造影证实30例为PE,1例多发大动脉炎;9例患者的V/Q显像为相匹配的肺叶、肺段或多发亚肺段的稀疏或缺损,提示不是PE,与肺动脉造影结果一致。核素V/Q显像诊断PE的灵敏度为100%(30/30例),特异性为90.0%(9/10例),准确性为97.5%(39/40例)。结论:多数PE患者通过核素肺V/Q显像可以作出明确诊断,少数肺V/Q显像与临床表现不符的患者需行肺动脉造影。

The value of pulmonary ventilation-perfusion imaging in the diagnosis of pulmonary embolism

Objective： To assess the value of ventilation-perfusion imaging in the diagnosis of pulmonary embolism （PE）. Method： Forty consecutive patients with clinically suspected pulmonary embolism were studied, mean age was （38.2±13.9）years. All patients underwent radionuclide ventilation-perfusion imaging and pulmonary angiography. Result： Of the 40 patients, 31 with lobe, multiple segment or mihisubsegment perfusion defects and normal or nearly normal ventilation images were reported as PE. 30 of them were confirmed to be with PE by pulmonary angiography, 1 patients were not confirmed. 9 of 40 patients with multiple perfusion defects, ventilative abnormalities were reported as non-PE and the diagnoses were confirmed by pulmonary angiography. The sensitivity, specificity and accuracy of diagnosis of PE by ventilation perfusion imaging was 100%, 90.0% and 97.5% respectively. Conclusion： The results suggest that pulnmnary embolism can be diagnosed non-invasively in most patients on the basis of clinical manifestation, chest radiograms and ventilation-perfusion imaging findings. Pulmonary angiography is required while clinical manifestation and ventilation perfusion imaging findings are discordant with each other.