肺通气/灌注显像与多层螺旋CT肺动脉造影诊断慢性血栓栓塞性肺动脉高压的前瞻性对比研究

目的 比较肺V/Q显像与多层螺旋CT肺动脉造影(CTPA)对慢性血栓栓塞性PAH(CTEPH)的诊断效能.方法 2006年1月至2010年12月间疑诊为CTEPH的PAH患者133例[男54例、女79例,15～78(43.1±14.9)岁]均在7d内接受肺V/Q显像、CTPA和肺动脉造影检查.以肺动脉造影为“金标准”,评价其他2种方法诊断准确性.V/Q显像结果包括CTEPH高度可能性、中度可能性和低度可能性;CTPA结果包括CTEPH阳性、阴性及不能诊断.应用Kappa检验分析这2种方法诊断结果的一致性.结果 其中51例患者被最终确诊为CTEPH(38.3％);其余82例中,60例诊断为IPAH,19例诊断为肺血管炎,3例为房间隔缺损.以CTEPH高度可能性作为阳性标准时,V/Q显像的诊断灵敏度为96.1％(49/51),特异性为75.6％(62/82),准确性为83.5％(111/133);以CTEPH高度和中度可能性均作为阳性标准时,V/Q显像的诊断灵敏度为100％(51/51),特异性为73.2％(60/82),准确性为83.5％(111/133).CTPA的诊断灵敏度为92.2％(47/51),特异性为92.7％(76/82),准确性为92.5％(123/133).V/Q显像以CTEPH高度可能性作为阳性标准时,V/Q显像与CTPA的诊断符合率为80.5％(107/133),Kappa=0.612,P＜0.001.结论 对于CTEPH的诊断,V/Q显像灵敏度较高;而CTPA则特异性较高,且对肺血管炎等其他PAH疾病鉴别力较好.两者结合可能有助于提高对CTEPH诊断的准确性.     

肺通气/灌注显像与多层螺旋CT诊断慢性血栓栓塞性肺动脉高压的对比研究

目的 对比肺通气/灌注(V/Q)显像与多层螺旋CT肺血管造影(CTPA)诊断慢性血栓栓塞性肺动脉高压(CTEPH)的准确性,评价2种影像学方法的诊断符合程度.方法 49例肺动脉高压患者,经超声心动图排除瓣膜性心脏病和先天性心脏病,既往无急性肺栓塞病史.所有患者先后行肺V/Q显像和CTPA检查,并以肺动脉造影为"金标准"进行对比评价.对V/Q显像和CTPA检查结果比较进行χ2检验,采用SPSS 12.0统计软件.结果 肺V/Q显像对CTEPH的诊断灵敏度、特异性和准确性分别为100.0%(17/17),71.9%(23/32)和81.6%(40/49),CTPA分别为94.1%(16/17),81.2%(26/32)和85.7%(42/49).肺V/Q显像与CTPA的诊断符合率为75.5%(37/49),Kappa值为0.513,2种影像学方法的诊断结果差异无统计学意义(χ2=0.75,P>0.05).结论 肺V/Q显像和CTPA均是诊断CTEPH有效的无创性影像学方法,两者结合应用有助于更好地诊断CTEPH.     

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.     

肺通气/灌注显像与磁共振肺动脉造影诊断肺栓塞初步对比分析

目的 通过对肺栓塞(PE)患者肺通气/灌注(V/Q)显像与磁共振肺动脉造影(MRPA)的初步对比分析,评价其临床价值.方法 28例临床及心电图改变怀疑PE的患者,其中男11例,女17例,年龄(50.1±14.4)岁,在3 d内分别行肺V/Q显像及MRPA.经肺动脉造影、手术及溶栓治疗有效证实为PE者22例,分为肺叶、肺段、亚肺段受累3个组.另6例经临床综合分析及随访诊断证实为非PE,其中1例经肺动脉造影证实.结果 肺叶PE组共10个肺叶受累,V/Q显像和MRPA检查结果一致.肺段PE组V/Q显像显示125段受累,MRPA检测139支段支动脉受累,后者检出肺段数高,但差异无统计学意义(P=0.110).亚肺段PE组,V/Q显像显示84个亚肺段受累,MRPA报告55个亚段动脉支受累,两者差异有统计学意义(P＜0.05).结论 对于肺叶和肺段PE,MRPA和V/Q显像都是灵敏的;对于亚肺段PE,V/Q显像明显优于MRPA.     

放射性核素肺显像与螺旋CT诊断急性肺栓塞的对比研究

目的 比较肺通气／灌注（V／Q）显像与多层螺旋CT肺动脉造影（CTPA）在诊断急性肺动脉血栓栓塞症（PTE）方面的临床价值。方法 前瞻性分析2005年10月～2006年5月共51例临床疑诊急性PTE患者的肺灌注显像，其中18例行肺通气显像，并与CTPA对比。以汇总所有临床资料、各实验室检查及影像学检查后讨论得出的最终诊断作为“标准”。结果 最终24位患者被诊断为PTE占47．1％（24／51例），V／Q显像与CTPA的灵敏度分别为95．8％（23／24例）和95．8％（23／24例），特异性分别为88．9％（24／27例）和92．6％（25／27例），准确性分别为92．2％（47／51例）和94．1％（48／51例）。在定性诊断方面，2种影像学检查结果差异无统计学意义（χ^2=0．14，P=0．71），两者定性诊断符合率为86．3％（44／51例），Kappa值为0．73。24例PTE患者中，CTPA显示为“完全阻塞”的肺动脉血管所对应的44个肺段中，肺灌注显像显示为“放射性稀疏、缺损”的肺段数为32个（72．7％）；CTPA显示为“部分充盈缺损”的肺动脉血管所对应的266个肺段中，肺灌注显像显示为“放射性稀疏、缺损”的肺段数为155个（58．3％），显示为“亚肺段放射性稀疏、缺损”的肺段数为9个（3．4％）。结论 V／Q显像与CTPA在PTE定性诊断方面符合率高，一致性好，但在定位方面存在差异；两者为互补关系。     

肺通气/灌注显像对急性肺血栓栓塞症患者的诊断价值

目的 评价放射性核素肺通气／灌注（V／Q）显像在急性肺血栓栓塞症（PTE）诊断中的价值及国人肺动脉血栓栓塞后肺血流灌注受损情况和受累肺段、肺叶的分布特点。方法 采用前瞻性描述性研究方法，将明确诊断为PTE的519例患者分为大面积、次大面积PTE组（249例）和非大面积（不含次大面积）PTE组（270例）。对519例急性PTE患者均进行了肺V／Q显像，其中有773例次与CT肺动脉造影（CTPA）结果进行了对比分析。结果 在治疗前行肺V／Q显像和CTPA的PTE患者中，PTE的总检出率分别为93．3％和89．3％（P〉0．05）；急性大面积和次大面积PTE组的检出率分别为86．9％和100％（P〈0．001）；急性非大面积PTE组的检出率分别为98．2％和77．5％（P〈0．001）。肺V／Q显像示病变分布的特点为：右肺多于左肺，下叶多于上叶，背段多于前段。肺V／Q显像与CTPA的符合率比较：肺高于肺叶，肺叶高于肺段，溶栓组高于抗凝组。结论 肺V／Q显像在急性PTE的诊断中具有重要的作用和独特的价值，与CTPA联合应用，可起到决定性的诊断作用。PTE患者肺内血栓的分布特点符合“浓度守衡定律”。     

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。     

肺灌注/通气显像与肺动脉造影诊断肺动脉栓塞的对比研究

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。方法临床疑有PE患者30例,男女各15例,平均年龄(38.2±13.9)岁。均行胸部X线片检查、核素V/Q显像和肺动脉造影。11例患者在行肺灌注显像时,选择双侧足背静脉注射肺灌注显像剂,同时完成双下肢静脉显像。结果30例患者中22例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;但肺动脉造影证实22例中20例为PE。8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%（20/20例）,特异性为80.0%（8/10例）,准确性为93.3%（28/30例）。X线胸片和核素下肢静脉显像有助于PE的正确诊断。结论多数PE患者通过核素肺V/Q显像结合X线胸片可以作出明确诊断,少数肺V/Q显像与临床表现不符的患者需行肺动脉造影。     

儿童闭塞性细支气管炎的核素肺灌注/通气显像研究

目的 了解闭塞性细支气管炎(BO)患儿的核素肺V/Q显像表现及该项检查在BO患儿临床诊断、病情评估、预后判断方面的价值.方法 前瞻性分析2005年2月至2011年4月在首都医科大学附属北京儿童医院呼吸感染中心确诊的30例BO患儿(男18例,女12例,年龄7个月～ 14岁)的核素肺V/Q显像资料,对不同病情和不同预后的BO患儿分别加以分析,比较其各自累及的肺段数.结果 30例BO患儿肺灌注显像异常25例(83.3％),肺通气显像异常27例(90.0％).异常肺V/Q匹配者13例(48.1％),不匹配者1例(3.7％),反向不匹配者13例(48.1％).3例轻度病情患儿中,1例肺V/Q显像正常,另2例仅1个肺段受累.10例中度病情患儿肺灌注显像异常平均累及3.7个肺段,肺通气显像异常平均累及5.6个肺段.17例严重病情患儿平均6.0个肺段肺灌注显像异常,平均8.2个肺段肺通气显像异常.30例患儿出院后随访到24例,其中8例病情加重患儿肺灌注显像异常累及肺段数量及受损程度明显高于16例复查好转患儿.结论 BO患儿的肺V/Q显像呈现肺段性、多发性肺灌注和(或)通气稀疏或缺损.该显像方法对BO患儿的临床诊断、病情评估及预后判断有重要意义.     

肺通气/灌注显像对肺动脉血栓内膜剥脱术后残余肺动脉高压的评价

目的:探讨慢性血栓栓塞性肺动脉高压(CTEPH)患者肺动脉血栓内膜剥脱术术前全肺灌注缺损百分比(PPDs%)与术后残余肺动脉高压发生的相关性。方法:回顾性分析2016年1月至2019年1月于阜外医院行肺动脉血栓内膜剥脱术并于术前术后均行核素肺通气/灌注(V/Q)显像的37例CTEPH患者[男21例、女16例,年龄(50...     

Virtual pulmonary arterioscopy in pulmonary embolic disease

16 slice multidetector CT provides virtual endoscopic views of the inside of arteries, or any other hollow structures. This is performed non-invasively using post-processing of three-dimensional isotropic image data sets, acquired during standard CT examinations. These virtual endoscopic views are simultaneously correlated with the standard multiplanar reconstructions, with the ability to navigate a virtual camera through the hollow structure under study. Normal and abnormal volume rendered images of the pulmonary arteries are presented in correlation with the multiplanar reformats. The abnormal images show the volume rendered appearances of acute and chronic pulmonary embolic disease. It is also postulated that this technique has a problem solving role in the differential diagnosis of chronic mural emboli from extravascular structures such as adjacent lymph nodes or bronchiolar impaction. This technique may also have a role in medical education, providing clinicians and medical students with interactive three-dimensional representations of disease processes.     

Unusual pulmonary angiographic findings in suspected pulmonary embolism

Pulmonary arteriography is most commonly performed to diagnose pulmonary embolism. A variety of clinical entities, however, may mimic pulmonary embolism both clinically and scintigraphically. Five patients with abnormal pulmonary arteriograms resulting from diseases other than pulmonary embolism are presented. The clinical, radiographic, and pathologic findings and long-term follow-up in these patients are described. Awareness of the angiographic patterns seen in these unusual cases is important in the differential diagnosis of pulmonary thromboembolism.     

CT-determined pulmonary artery diameters in predicting pulmonary hypertension

This study was to determine if the diameters of pulmonary arteries measured from computed tomographic (CT) scans could be used 1) as indicators of pulmonary artery hypertension and 2) as a reliable base for calculating mean pulmonary artery pressure. The diameters of the main, left, proximal right, distal right, interlobar, and left descending pulmonary arteries were measured from CT scans in 32 patients with cardiopulmonary disease and in 26 age- and sex-matched control subjects. Diameters were measured using a special computer program that could display a CT density profile of the artery and its adjacent tissues. The upper limit of normal diameter for the main pulmonary artery was found to be 28.6 mm (mean + 2 SD). In the patient group, the diameters were correlated with data from cardiac catheterization. In these patients, a diameter of the main pulmonary artery above 28.6 mm readily predicted the presence of pulmonary hypertension. The calculated cross-sectional areas of the main and interlobar pulmonary arteries (normalized for body surface area [BAS]) were found to give the best estimates of mean pulmonary artery pressure (r = 0.89, P less than 0.001 and r = 0.66, P less than 0.001). Multiple regression analysis gave the useful equation: mean pulmonary artery pressure = -10.92 + 0.07646 X area of main pulmonary artery/BSA + 0.08084 X area of the right interlobar pulmonary artery/BSA (r = 0.93, P less than 0.0001). Because CT allows precise, noninvasive measurement of the diameter of pulmonary arteries, it can be of value in detecting pulmonary hypertension and estimating mean pulmonary artery pressure.     

Angiography and perfusion pulmonary scintigraphy in pulmonary embolism

Clinical signs suggestive of pulmonary embolism require diagnostic confirmation from complementary scintigraphic and/or angiographic examinations, therapy being adapted to the results obtained. A comparative study of the value of the two techniques was conducted in 20 patients with suspected pulmonary embolism investigated by a perfusion pulmonary scan and selective pulmonary angiography. Results confirmed the diagnostic superiority of angiography, the high percentage of false positives obtained by perfusion scintigraphy alone indicating the need for associated ventilatory function tests.     

The relationship between pulmonary artery pressure and pulmonary artery diameter in pulmonary hypertension

The pulmonary arteries dilate in response to many factors, principally increased pressure and flow. In patients who have pulmonary arterial hypertension but no increase in flow, we have compared main pulmonary artery size at computed tomography with pulmonary haemodynamic data obtained during right heart catheterisation. In patients with primary pulmonary hypertension and chronic thromboembolic pulmonary hypertension, dilatation correlated with raised pulmonary vascular resistance and reduced cardiac output but not with mean arterial pressure. In patients with chronic lung disease no correlations were shown though a trend between raised pressure and size was observed. We speculate that pulmonary artery compliance is an important factor which determines the degree of dilatation in response to raised pressure. Estimations of pressure cannot be made from measurements of pulmonary artery size without knowledge of the underlying lung disease.     

Follow-up pulmonary perfusion scintigraphy pulmonary arterial embolization in two cases of familial pulmonary arteriovenous fistula

Follow-up pulmonary perfusion scintigraphy in evaluating pulmonary arterial embolization were assessed by two cases of pulmonary familial arteriovenous fistula. Pulmonary arteriovenous fistula was found for brain abscess in the older brother, and for dyspnea on effort in the younger brother. Pulmonary arterial embolizations were performed. (older brother: 4 times, younger brother: 5 times) Before embolization, pulmonary perfusion scintigram showed pale defect, clear asymmetric perfusion between right and left lung, and clear renal visualization. On the other hand, after the embolization, clear multiple defects agreed with the sites of embolization, and asymmetric pulmonary perfusion and renal visualization disappeared. We conclude that follow-up pulmonary perfusion scintigraphy is useful to evaluate in pulmonary arteriovenous fistula after embolization.     

螺旋CT肺动脉造影对肺栓塞的诊断

目的：评价螺旋CT及其肺动脉造影诊断肺动脉栓塞（PE）的价值。方法：回顾性分析12例PE患,均行螺旋CT容积扫描,并在工作站进行图像后处理,获得肺动脉多平面重建图像及三维立体图像。结果：对12例196支肺动脉分支进行分析,受累率为46.4%;栓子发生在主肺动脉、左右肺动脉干及叶段肺动脉。多平面重建图像上表现为充盈对比剂血管内有充盈缺损区,或其远侧方无对比剂充填区。肺动脉成像示,主干血管内可见充盈缺损影,或呈截断状影;叶栓塞或段栓塞亦呈突然“截断状”,其远侧方肺动脉分支不显影或呈纤维状。结论：螺旋CT肺动脉造影不仅可以获得轴位图像,而且可以获得立体图像,可多轴向旋转观察PE部位,是诊断叶或段以上PE可靠而直观的检查方法。     

Quantitative lobar pulmonary perfusion assessment on dual-energy CT pulmonary angiography: applications in pulmonary embolism

To assess quantitative lobar pulmonary perfusion on DECT-PA in patients with and without pulmonary embolism (PE). Our retrospective study included 88 adult patients (mean age 56 ± 19 years; 38 men, 50 women) who underwent DECT-PA (40 PE present; 48 PE absent) on a 384-slice, third-generation, dual-source CT. All DECT-PA examinations were reviewed to record the presence and location of occlusive and non-occlusive PE. Transverse thin (1 mm) DECT images (80/150 kV) were de-identified and exported offline for processing on a stand-alone deep learning–based prototype for automatic lung lobe segmentation and to obtain the mean attenuation numbers (in HU), contrast amount (in mg), and normalized iodine concentration per lung and lobe. The zonal volumes and mean enhancement were obtained from the Lung Analysis™ application. Data were analyzed with receiver operating characteristics (ROC) and analysis of variance (ANOVA). The automatic lung lobe segmentation was accurate in all DECT-PA (88; 100%). Both lobar and zonal perfusions were significantly lower in patients with PE compared with those without PE (p < 0.0001). The mean attenuation numbers, contrast amounts, and normalized iodine concentrations in different lobes were significantly lower in the patients with PE compared with those in the patients without PE (AUC 0.70–0.78; p < 0.0001). Patients with occlusive PE had significantly lower quantitative perfusion compared with those without occlusive PE (p < 0.0001). The deep learning–based prototype enables accurate lung lobe segmentation and assessment of quantitative lobar perfusion from DECT-PA. • Deep learning–based prototype enables accurate lung lobe segmentation and assessment of quantitative lobar perfusion from DECT-PA. • Quantitative lobar perfusion parameters (AUC up to 0.78) have a higher predicting presence of PE on DECT-PA examinations compared with the zonal perfusion parameters (AUC up to 0.72). • The lobar-normalized iodine concentration has the highest AUC for both presence of PE and for differentiating occlusive and non-occlusive PE.     

MR灌注成像在肺栓塞诊断中的应用

目的探讨MR二维快速扰相梯度回波序列（2DFSPGR）显示肺实质灌注的可能性,以及在实验性肺栓塞中的应用价值。方法11只在体犬肺栓塞模型在平静呼吸下行肺MR灌注扫描,定性及定量评价图像质量,与病理解剖对照分析肺灌注扫描诊断肺栓塞的敏感性。结果10只犬的MR图像质量为优良,可显示肺实质灌注情况,平均信号/噪声比（SNR）为67.4±18.0,对比度/噪声比（CNR）为40.9±14.2。正常灌注区的信号强度平均值为39.7±5.1,灌注不良区域信号强度平均值为15.6±2.1,灌注不良区域时间-强度曲线表现为峰值下降或曲线平直。结论MR肺灌注成像是诊断肺栓塞的可行方法。