^99Tcm-聚合白蛋白肺灌注显像对肺栓塞溶栓疗效的评价

目的 探讨^99Tcm-聚合白蛋白（^99Tcm-MAA）肺灌注显像评价肺栓塞溶栓治疗的价值。方法对54例急性肺栓塞的患者进行回顾性分析,所有患者均由^99Tcm-MAA肺灌注显像结合X线胸片检查确诊,并于溶栓治疗1周后复查肺灌注显像,部分病例于治疗3个月后再次复查。结果54例急性肺栓塞患者溶拴治疗前^99Tcm-MAA肺灌注显像共观察到347个受损肺段,X线胸片均无相应肺段或亚肺段异常。溶栓治疗后1周复查肺灌注显像,164个受损肺段（47．3％）恢复正常;3个月后再次复查,199个受损肺段（57．4％）恢复正常（χ^2=10．68,P〈0．05）。结论^99Tcm-MAA肺灌注显像是一种无创的诊断方法,对肺栓塞溶栓治疗效果的评估有重要价值。     

急性肺血栓性栓塞的核素显像诊断与疗效判断(附10例报告)

目的评价核素显像对急性肺血栓性栓塞的诊断与疗效评价的价值。方法对１０例临床确诊或可疑为肺栓塞的患者进行核素肺灌注、肺通气、肺血栓灶以及双下肢深静脉显像，４例与肺动脉造影或电子束ＣＴ结果对照。８例患者溶栓后复查肺灌注显像，２例患者复查肺血栓灶显像。结果肺灌注显像＋下肢深静脉显像对急性肺栓塞诊断的阳性率为１００％，与Ｘ线检查结果基本一致，溶栓后复查提示肺血流均有明显改善乃至恢复正常。结论核素显像对诊断急性肺栓塞以及判断疗效是一种准确、可靠的无创性手段。     

急性脑血栓性栓塞的核素显像诊断与疗效判断

目的 评价核素显像对急性肺血栓性栓塞的诊断与疗效评价的价值。方法对１０例临床确诊或可疑为肺栓塞的患者进行核素肺灌注、肺通气、肺血栓灶以及双下肢深静脉显像，４例与肺动脉造影或电子束ＣＴ结果对照。８例患者溶栓后复查肺灌注显像，２例患者昨查肺血栓灶显像，结果 肺灌注显像＋下肢深静脉显像对急性肺栓塞诊断的阳性率为１００％，与Ｘ线检查结果基本一致，溶栓后复查提示肺血流均有明显改善乃至恢复正常。结论 核素显像     

核素肺通气/灌注显像对肺栓塞患者溶栓疗效的观察

目的评价肺通气/灌注显像监测肺栓塞患者治疗疗效的价值。方法47例确诊为肺栓塞的患者，男27例，女20例，平均年龄(52.8±16.1，19～81)岁。受累肺段共564段，平均(12.5±4.6)段。分为3组，第1组为病程1周以内，共17例；第2组为病程在1～2周及病程大于1个月而近2周有发作或加重，共16例；第3组为病程＞1个月而无近期发作，共12例。另有2例病程大于2周、小于1个月。溶栓抗凝治疗5～10d后复查，8例口服抗凝剂6～18个月后再次复查。均于治疗前及溶栓后5～10d、单纯抗凝2～4周后行肺灌注显像，采集条件一致。结果第1组患者有75.5％肺段血流灌注改善，第2组有74.3％肺段血流灌注改善，两者间差异无显著性，第3组仅见5.3％的肺段有改善，与前2组相比差异有显著性(P＜0.001)。2例病程大于2周、小于1个月的患者亦有明显疗效。8例长期口服抗凝剂的患者，有87.5％肺内血流灌注进一步改善。结论肺通气/灌注显像在肺栓塞患者疗效评价中有重要价值。以病程2周为时间窗，溶栓疗效显著。病程在2周以上甚至大于1个月的肺栓塞患者有一定疗效。     

肺通气/灌注显像对肺栓塞疗效的评价

目的 探讨肺通气／灌注（V／Q）显像在观察肺栓塞（PE）溶栓和抗凝治疗效果中的价值。方法 对65例抗凝和溶栓治疗的PE患者，治疗前后分别给予^99Tc^m气体37-74MBq和^99Tc^m-聚合白蛋白（MAA）148—185MBq后行8个体位V／Q显像；并在治疗后不同时间多次重复V／Q显像。结 果44例PE患者296个受损肺段，单纯抗凝治疗1年半内，V／Q显像显示106个肺段恢复正常（35．8％），69个受损肺段改善（23．3％），121个肺段无改善（40．9％）。21例PE患者165个受损肺段，溶栓结合抗凝治疗后V／Q显像示有85个肺段恢复正常（51．5％），有29个肺段改善（17．6％），有51个肺段无改善（30．9％）。其中在PE发病7d内治疗效果最佳，单纯抗凝治疗7d与14d疗效之间比较及溶栓结合抗凝治疗7d与14d疗效之间比较，差异均有统计学意义（χ^2=8．79和56．31，P〈0．05和〈0．01）。结论 V／Q显像能较好地评价PE抗凝和溶栓治疗效果。     

99Tcm-MAA肺灌注显像评价肺动脉血栓内膜剥脱术疗效

目的 应用99Tcm-大颗粒聚合白蛋白(MAA)肺灌注显像评价肺动脉血栓内膜剥脱术对慢性栓塞性肺动脉高压(CPTH)疗效,并与电子束CT(EBCT)进行对比.方法 9例CPTH患者,于手术前、术后早期(6～30 d)和术后远期(6～12个月)分别进行肺灌注显像,对图像进行逐个肺段的定性和半定量分析,比较手术前后肺血流灌注的变化,并与EBCT进行逐个肺段的对比分析.结果 术前99个肺段显示灌注异常,术后早期42个(42.4%)恢复正常,28个(28.3%)部分改善;术后远期完全恢复的肺段为69.7%(69/99个).术前全肺灌注缺损百分数(PPDs%)平均为(60.8±6.5)%,术后早期下降为(46.1±11.8)%(P＜0.01);术后远期进一步下降为(13.3±13.5)%(P＜0.01).按肺段统计,手术前后肺灌注显像与EBCT结果均符合为60.3%.结论 99Tcm-MAA肺灌注显像是评价肺动脉血栓内膜剥脱术后疗效的有效方法.     

肺灌注显像结合X线胸片诊断急性肺栓塞

目的探讨肺灌注显像／x线胸片检查（Q／X）替代肺灌注／通气显像（Q／V）用于急性肺栓塞诊断的可行性。方法72例疑诊急性肺栓塞，且肺灌注显像显示至少有一个肺段灌注缺损的患者，24h内行x线胸片检查和肺通气显像，比较Q／X和QIV的诊断符合率和准确性。结果Q／x与Q／V结果的符合率为84．7％，Q／x对Q／V的阳性预测值为83．7％，阴性预测值为87．0％。在该组病例中，Q／X诊断急性肺栓塞的灵敏度为94．9％，特异性为63．6％，准确性为80．6％；而Q／V则分别为94．9％，78．8％和87．5％。5例慢性阻塞性肺部疾病（COPD）Q／X均显示不匹配，而Q／v均显示匹配，两者结果不同。结论对于多数疑诊急性肺栓塞患者，Q／X可以替代Q／v用于诊断，但对于COPD患者应选择Q／V。     

硝酸甘油介入99Tcm-MIBI SPECT心肌显像对PTCA决策的影响

目的评价硝酸甘油(NTG)介入99Tcm-甲氧基异丁基异腈(MIBI) SPECT心肌显像对心肌梗死患者行经皮冠状动脉腔内成形术(PTCA)决策的影响.方法 51例心肌梗死患者PTCA前1周内行99Tcm-MIBI静息和NTG介入心肌显像,术后2～3个月内复查静息心肌显像,并进行对比分析.结果 51例患者共141个心肌灌注异常节段,其中术后74个节段心肌血流灌注改善,治疗有效率为52.48%.术前NTG介入显像表现为可逆性缺损79个节段,术后84.81%(67个)节段心肌灌注改善,其中有明显填充的58个节段,术后全部灌注改善.NTG介入显像表现为不可逆性缺损的62个节段,有11.29 %(7个)节段术后心肌灌注改善.NTG介入显像检测心肌存活的准确性为86.52%.结论 NTG介入99Tcm-MIBI SPECT心肌显像对患者行PTCA起重要的决策作用.     

核素显像在肺栓塞诊断及预后评价的价值(附65例分析)

目的：讨论核素显像在肺栓塞（PE）诊断及预后评价的价值。方法：收集2002年1月-2004年6月经核素显像诊断并结合临床确诊的PE患者65例，其中42例患者在治疗后2周、3个月通过肺灌注显像进行复查，用以评价PE的治疗效果。结果：核素肺显像对PE的诊断准确率为93．8％，双下肢深静脉显像对于深静脉血栓的诊断准确率达88．7％，肺灌注显像复查示治疗后2周受累肺段消退率为44．2％，3个月受累肺段消退率为72．8％。结论：核素显像无创、简便、费用低、可重复进行，是PE诊断及预后评价的首选方法。     

核素肺灌注显像结合PISA-PED评价标准与CT肺动脉造影诊断肺栓塞的对比研究

目的 比较核素肺灌注显像结合PE诊断前瞻性研究(PISA-PED)评价标准与CT肺动脉造影(CTPA)诊断PE的效能.方法 前瞻性纳入104例连续性疑似PE患者,其中男54例,女50例,年龄(50±15)岁.排除标准为:孕妇、肾功能衰竭患者、已接受溶栓或抗凝治疗患者或有造影剂过敏史患者.所有患者均行核素肺灌注显像、CTPA及胸部X线检查.采用PISA-PED评价标准判读核素肺灌注显像图.最终诊断采用临床综合诊断.应用Kappa检验分析肺灌注显像与CTPA结果的一致性,应用非参数检验或x2检验分析2种诊断方法结果间的差异性.结果 104例患者中55例被最终诊断为PE.在排除3例(2.9％)CTPA“不能诊断”者后,肺灌注显像的灵敏度、特异性、阳性预测值及阴性预测值分别为92.6％ (50/54)、83.0％( 39/47)、86.2％( 50/58)和90.7％ (39/43);CTPA的灵敏度、特异性、阳性预测值及阴性预测值分别为96.3％ (52/54)、93.6％( 44/47)、94.5％( 52/55)和95.7％ (44/46).2种显像方法的诊断符合率为89.1％(90/101),Kappa =0.78,P＜0.05.在肺段水平,共分析了1664个肺段,肺灌注显像与CTPA的诊断符合率为79.7％ (1327/1664),Kappa=0.58,P＜0.05.结论 核素肺灌注显像结合PISA-PED评价标准与CTPA诊断PE的效能相近,两者均有较好的诊断效能.2种显像方法在肺段水平为中度符合.     

Long-term outcome in nonmassive pulmonary embolism. Radiologic, scintigraphic and functional correlation

54 cases of acute pulmonary embolism were followed for 3 to 4 years by serial chest radiography (plain film and tomography) to survey the radiographic outcome of complete and incomplete pulmonary infarcts in man. A perfusion lung scan (99Tcm-MAA), arterial blood gas analysis and spirometric data were recorded at similar time intervals to chest films in 30 patients. Our retrospective study showed that the most common long-term residual radiographic findings were linear pulmonary scars and localized pleural thickening. The analysis of the radiographic abnormalities with the lung scan showed a residual perfusion defect in 29% of cases, with complete clearing of the infarct on chest radiography. Long term impairment of pulmonary function, estimated with arterial blood gas analysis and spirometric tests, was never observed.     

Arterial oxygen saturation in patients undergoing perfusion lung scanning with 99Tcm-labelled macroaggregates of human serum albumin

Radionuclide imaging of the lungs with 99Tcm-labelled macroaggregates of human serum albumin (99Tcm-MAA) is a safe, reliable and non-invasive method of diagnosing pulmonary embolism. It has been suggested that following intravenous injection of 99Tcm-MAA, arterial oxygen saturation falls significantly. Oxygen saturation was measured in 101 patients who had received an intravenous injection of 99Tcm-MAA prior to a perfusion lung scan. Readings were taken using a pulse oximeter at rest, immediately following injection, 10, 30 and 60 min post-injection. Twenty-five normal volunteers who were not injected acted as controls. Forty patients showed no change in oxygen saturation throughout the study. A fall of 1% was seen in 32 patients and 2-3% in 26 patients. Of the three patients who demonstrated a reduction in saturation of 6, 7 and 13%, two had chronic airways disease and one had left ventricular failure. Twenty out of 25 normal controls showed no change in saturation over the period of observation. Five showed a fluctuation of 1-2% between the measurements. All patients and controls remained asymptomatic with almost all readings returning to the initial values after 1 h. It was the patients with chest or heart disease who showed a fall in saturation. The study shows that the majority of patients undergoing a perfusion scan with 99Tcm-MAA show no significant fall in oxygen saturation. If a fall occurs, it may be related to the underlying disease process rather than to 99Tcm-MAA.     

Clinical and experimental studies on the mechanism of abnormal accumulation in lung scanning with 123I-IMP.

To investigate the intrapulmonary kinetics of N-isopropyl-p-I-123-iodoamphetamine (123I-IMP), lung scanning with 123I-IMP was performed in patients with various lung disorders. Compared with the normal lung field, abnormal accumulation of 123I-IMP was detected in all patients in delayed imaging performed 24 h after 123I-IMP injection. These sites were within areas of absent or reduced perfusion observed by pulmonary perfusion scanning using 99Tcm-macroaggregated albumin (99Tcm-MAA). A similar phenomenon was seen in additional experiments in rabbits with regional pulmonary arterial hypoperfusion resulting from a balloon catheter-induced bronchial occlusion. 123I-IMP accumulation in areas where 99Tcm-MAA images are absent or decreased may be explained by the ability of 123I-IMP to penetrate significantly narrowed microvascular beds with reduced perfusion. Our clinical and experimental results indicate that pulmonary arterial perfusion, particularly hypoperfusion, influence the pulmonary kinetics of 123I-IMP. This compound is a potentially useful non-particulate agent for the assessment of pulmonary arterial perfusion.     

Visualization of functional improvement by 123I-IMP lung SPET after thromboendarterectomy for chronic pulmonary embolism

We report on six patients with chronic pulmonary embolism who underwent 123I-IMP and 99Tcm-MAA lung SPET before and after thromboendarterectomy. 123I-IMP lung SPET can assess the viability of lung parenchyma, because it is a non-particulate agent that accumulates in the endothelial membranes of pulmonary capillaries. Chronic pulmonary thromboembolism accompanied by pulmonary hypertension has a poor prognosis that may be improved only by thromboendarterectomy. We compared 123I-IMP and 99Tcm-MAA lung SPET in terms of functional improvement after such surgery. After thromboendarterectomy, all six patients were functionally improved, according to the criteria of the New York Heart Association. The pre- and post-surgery percentage of vascular obstruction did not differ significantly with 99Tcm-MAA lung SPET (44.8 +/- 11.2% and 32.5 +/- 15.6% pre- and post-surgery, respectively). In contrast, 123I-IMP lung SPET revealed a significant pre- versus post-surgery difference (15.5 +/- 9.5% and 3.3 +/- 5.9% pre- and post-surgery, respectively). 123I-IMP lung SPET could be useful for evaluating thromboendarterectomy because pulmonary parenchymal viability owing to arterial microvasculature can be estimated.     

64层CT血管成像与肺通气灌注显像诊断肺栓塞的对比研究

目的:通过比较两种无创影像检查为临床诊断肺栓塞提供有指导意义检查方法。方法:64层螺旋CT肺动脉成像和肺通气/灌注显像图像依据相同的诊断标准进行独立的分析。V/Q显像和多层螺旋CT肺动脉成像两种检查方法的判定结果进行相关分析,两者准确性、符合性及不确定性诊断比率的差异采用2检验进行比较。结果:180例患者中CTPA和V/Q显像诊断PE的敏感性、特异性、符合率分别为90.5%对83.8%,91.5%对85.0%,91.1%对84.4%。CTPA和V/Q显像诊断PE的κ值分别为0.680,0.648。结论:疑诊肺栓塞病例中两者皆可作为确诊及排除疑诊肺栓塞病例的检查方法。     

双源CT双能量肺灌注成像对肺栓塞的初步研究

目的 探讨双源CT双能量扫描肺灌注成像的临床诊断价值.方法 选择临床怀疑肺动脉栓塞30例患者行双源CT双能量扫描,生成140、80 kV和融合系数为0.3的3组数据.根据融合数据的CT肺动脉造影(CTPA)图像将患者分为肺栓塞组和正常组.采用双能量评估软件将薄层重建数据进行灌注成像分析,将双肺野分为上、中、下3部分,正常组受试者肺组织灌注定量的双侧比较行配对t检验,2组间肺组织灌注量比较行独立样本t检验,并对融合图像行MinIP,评估肺组织通气情况.结果 正常组(16例)肺灌注均匀,无明显灌注缺损及减弱,灌注定量分析显示左、右全肺的灌注量分别为(27±7)、(28±8)HU,两侧比较差异无统计学意义(t=-1.73,P＞0.05);左肺上、中、下部的灌注量分别为(23±6)、(24±6)、(28±8)HU,右肺上、中、下部灌注量分别为(26±8)、(27±8)、(28±9)HU,两侧分别比较差异均无统计学意义(t值分别为-1.91、-1.96、-1.73,P值均＞0.05).肺栓塞组(14例)CTPA图像显示肺动脉干、段及亚段充盈缺损,肺灌注成像表现为栓塞血管所支配肺野区域的灌注缺损或缺失,灌注定量分析显示全肺及中、下肺的灌注量分别为(22±5)、(22±8)、(21±8)HU,与正常组分别比较差异均有统计学意义(t值分别为-2.10、-2.32、-2.63,P值均＜0.05＝.MinIP显示通气异常区与灌注异常区具有良好的一致性.结论 双源CT双能量扫描可用于肺栓塞的诊断,有利于肺栓塞的早期发现和精确解剖定位.

Abstract：

Objective To explore the diagnostic values of dual energy lung perfusion in the diagnosis of pulmonary embolism by using dual-source CT (DSCT). Methods Thirty patients with clinically suspected pulmonary embolism underwent dual-energy scanning with dual-source CT. The scanned data were integrated into three groups including 140, 80 kV and coefficient of 0.3. According to the CT pulmonary angiography (CTPA) of the fusion data, the patients were divided into pulmonary embolism group and normal group. The thin-slice reconstruction of data was analyzed using dual-energy perfusion imaging analysis software. The lung field was divided into upper, middle and lower part to make quantitative analysis of lung tissue perfusion. Paired t-tests were used in the normal patients to compare bilateral lungs, and independent samples t-tests were applied to compare the embolism group and normal group, while minimum intensity projection images (MinIP) were utilized in the assessment of lung ventilation. Results Dual energy CT showed symmetrical homogeneous perfusion in 16 normal cases, without significant perfusion defects. Quantitative analysis showed that left and right lung perfusion were (27 ± 7) and (28 ± 8 ) HU respectively, and no significant difference was found between the two sides ( t=-1.73, P ＞0.05 ).Perfusion of the left upper, middle and lower lung was ( 23 ± 6), (24 ± 6), and (28 ± 8) HU respectively, while the perfusion of right upper, middle and lower lung was (26 ±8), (27 ±8), and (28 ±9) HU respectively, showing no statistical significant difference between the two sides (t=-1.91, -1.96,-1.73 ,P＞0.05 ). Angiography of pulmonary embolism group(14 cases)showed filling defects in the pulmonary trunk, segments and sub-segments. Pulmonary perfusion imaging showed low perfusion or defectsin lung field that dominated by embolic vessels. Quantitative analysis showed that the perfusion of the whole lung and the middle and lower lung were (22 ±5), (22 ±8), and (21 ±8) HU in the embolism group,which were significantly different from the normal group (t=-2. 10, -2.32, -2.63, P＜0.05).Minimum intensity projection images showed a good consistency of abnormal ventilation zone area and perfusion abnormalities. Conclusions Pulmonary perfusion status, especially pulmonary embolism, can be analyzed by dual energy CT scanning. It helps to early discover and precisely locate the embolism.     

核素肺灌注显像对急性肺栓塞诊断的临床价值

目的评价放射性核素肺灌注显像在诊断急性肺动脉栓塞中的价值。方法对临床怀疑有急性肺动脉栓塞的25例患者进行了放射性核素肺灌注显像,同时行双下肢深静脉显像。结果25例患者中有23例出现不同程度的多发肺段血流灌注异常,其中41个肺段出现放射性缺损区,84个肺段出现放射性稀疏区。25例患者6例双下肢深静脉血栓形成。结论放射性核素肺灌注显像是诊断急性肺动脉栓塞的一种无创伤性的有效的检查方法。     

99Tcm-大颗粒聚合白蛋白显像在下肢深静脉血栓中的诊断价值

目的 探讨99Tcm-大颗粒聚合白蛋白( 99Tcm-M AA)核素深静脉显像(RNV)对下肢深静脉血栓(DVT)的诊断价值.方法 临床疑似下肢DVT的患者45例,均行99Tcm-MAA双下肢RNV,并与临床最终诊断结果进行对照.结果 43例共51条患肢经临床确诊,51条血栓性患肢中,左下肢36条、右下肢15条,左下患...     

Aerosol-perfusion lung scintigraphy: value of ventilation subtraction

99Tcm-labelled aerosol ventilation and 99Tcm-macroaggregate albumin (99Tcm-MAA) perfusion can be performed in the diagnosis of pulmonary embolism (PE). If both examinations are performed on the same day, the superposition of activity from the first scintigraphic examination might mask defects in the second. In this study, 106 examinations were carried out for suspected PE. Aerosol ventilation was performed first with 20 to 30 mCi 99Tcm-labelled rhenium sulphur (four views, 200,000 counts). Immediately afterwards, with the patient remaining in the same position, 5 to 7 mCi of 99Tcm-MAA were injected (four views, 400,000 counts). After normalization, aerosol activity was subtracted from perfusion images and unprocessed perfusion (UP) and ventilation subtraction perfusion (SP) images were compared. Interobserver diagnostic reproducibility between three readers was calculated both for UP and SP images. Intraobserver reproducibility between UP and SP images was calculated for each reader. Interobserver reproducibility was comparable for SP and UP images. Intraobserver reproducibility was good. Thus, whether ventilation was subtracted or not from perfusion images, there was no appreciable effect on perfusion defect detection. However, some perfusion abnormalities showed up more clearly on SP images. Perfusion can be performed immediately after aerosol ventilation; the images thus obtained are reliable for interpretation, and subtraction of ventilation is not necessary.