肺通气／灌注比值显像在肺血栓栓塞症诊断中的价值

目的：探讨肺通气／灌注（V／P）比值显像在肺血栓栓塞症（PTE）诊断中的价值。方法：对10例临床确诊的PTE患者V／P显像,并行定量分析。结果：10例患者共43个肺段经临床确认为肺血栓栓塞,常规目测读片诊断肺血栓栓塞46个,其中符合临床37个,灵敏度86．05％,特异性93．43％。V／P比值显像诊断肺血栓栓塞41个,与临床符合39个。灵敏度90．70％,特异性98．54％。结论：V／P比值显像可明显提高特异性。     

肺通气／灌注SPECT显像在急性肺栓塞诊断中临床应用进展

文章综述了肺通气／灌注（V／Q）平面显像及CT肺血管造影（CTPA）在急性肺栓塞诊断中的应用,旨在引导临床医生选择最佳影像学检查手段。另一方面阐述肺通气／灌注单光子正电子发射计算机断层显像（SPECT）的相关进展,综述该技术在不同肺部疾病诊断中的临床应用。     

放射性核素显像在心肌病诊治中的临床应用

心肌病是指伴有心肌功能障碍的心肌疾病。根据病理生理学可分为4型，即肥厚型心肌病（HCM）、扩张型心肌病（DCM）、限制性心肌病（RCM）以及致心律失常型右室心肌病（ARVD／C）。其中HCM与DCM在临床中较为常见。HCM的发病率大约为1／500^[1-2]，而DCM的发病率为13／10万～84／10万不等^[3]。目前HCM与DCM的发病病因及致病机理尚不确切明了。     

肺通气／灌注显像在肺动脉栓塞疾病诊断中的价值

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。方法临床疑有PE患者147例,均行肺通气／灌注（V／Q）显像。结果147例患者中有91例V／Q显像诊断PE,56例V／Q像正常或匹配,排除PE。临床最终确诊PE83例,4例大动脉炎,4例正常。56例V／Q显像正常或匹配者均排除PE。肺V／Q显像对诊断PE的灵敏度、特异性、准确性、阳性预测值和阴性预测值分别为100％（83／83）、87．5％（56／64）、946％（139／147）、912％（83／91）和100％（56／56）。结论V／Q显像灵敏度及阴性预测值高,提示其检出疾病的能力强,漏诊率低,且可作为排除PE的首选方法。     

放射性核素脑显像在脑血管疾病中的应用

放射性核素脑显像是把放射性核素示踪剂引人体内;用探头在体外探查核素在靶器官内的动态和（或）静态分布状况的核医学诊断方法。根据放射性核素示踪剂特定的生理生化特征,可了解脑的功能和生理方面的变化。因此,放射性核素脑显像是脑的功能性显像,可以探查脑的血流灌注、代谢、神经受体等功能方面的变化。这些变化常在脑的结构性损伤之前出现,是疾病早期的病理生理异常表现;也可在经过治疗,脑的结构损伤恢复正常后继续存在,并对后遗症的发生起重要作用;有些脑病可能不出现脑组织的结构变化,放射性核素脑显像可以提供有价值的信息…     

肺通气/灌注显像在肺栓塞诊断中的应用及进展

肺通气/灌注显像在急性肺栓塞的临床诊疗中常被用为一线影像学检查,随着多种影像学技术的发展,从显像技术到放射性药物方面均有较大进步。本文针对肺通气/灌注显像在急性肺栓塞诊断中的应用及进展进行综述。     

放射性核素显像对闭塞性肺血管病肺动脉高压的诊断价值

根据肺动脉造影和肺灌注显像检查。65例闭塞性肺血管病中,33例诊断为肺栓塞症(大块),肺灌注显像呈肺段以上分布的血流灌注缺损;32例不能解释的肺动脉高压中,20例诊断为慢性哑型肺血栓栓塞症,肺灌注显像呈不均匀的斑片状稀疏缺损;12例诊断为真正的原发性肺动脉高压症,肺灌注显像为正常或普遍稀疏。65例中63例肺动脉平均压增高,升高程度与肺血流受损范围和程度相关。     

核素肺灌注／通气显像对肺栓塞治疗效果分析

目的:用肺灌注/肺通气显像评价肺栓塞患者治疗疗效。方法:将57例肺栓塞的患者根据病程分3组,病程1周内为第1组19例;1周～1个月为第2组27例;>1个月的为第3组11例。3组均通过不同疗程后定期行~(99m)Tc- MAA(大颗粒聚合白蛋白)和~(99m)Tc-DTPA(喷替酸)肺灌注/肺通气显像随访观察。结果:栓塞肺段血流灌注不同程度改善:第1组79.9%(111/139段);第2组78%(117/150段);第3组7.1%(9/130段),第3组与前两组比较有差异(P<0.05)。结论:肺灌注/肺通气显像有助于肺栓塞治疗随访和疗效评估。     

彩色多普勒血流显像在甲状腺疾病中的应用

目的：评价彩色多普勒血流显像（CDFI）对甲状腺疾病诊断的临床价值。方法：采用CDFI对116例甲状腺疾病进行检测，其中弥漫性甲状腺肿67例（42例为Graves病，25例为桥本氏甲状腺炎）。测量甲状腺上动脉的血流指标（D、Vp、Vm、RI、Q），在两组中采用t检验进行对比。49例甲状腺肿块进行了手术，将术前超声诊断与术后病理诊断进行比较。结果：67例弥漫性甲状腺肿大的Graves病的血流指标与桥本氏甲状腺炎的血流指标有显著差异（P＜0．005），在49例甲状腺肿块中，42例术前超声与术后病理诊断符合，符合率85．7％，误诊率14．3％。结论：联合应用HFU和CDFI对甲状腺疾病的诊断与鉴别诊断有一定的临床价值。     

彩色多普勒血流显像在诊断甲状腺疾病中的应用

近年来,由于超声仪器采用了先进的计算机技术超声图像处理方法,特别是高频探头的改进,超宽频率连续动态聚焦的出现,使浅层器官和组织的分辨率和图像质量有了新的飞跃,加之彩色多普勒技术在甲状腺上的应用,使甲状腺超声诊断提高到一个新的水平。现将我们应用彩色多普...     

Assessment of ventilation inhomogenity with Krypton SPECT and planar imaging

In 29 chronic obstructive pulmonary disease (COPD) patients and nine lung healthy volunteers, above the age of 50 years, ventilation defects were examined by (81m)Kr planar scintigraphy and (81m)Kr single photon emission computed tomography (SPECT) to investigate if SPECT adds information regarding size and extent of visually scored ventilation defects, and to correlate the extent of defects obtained from the two imaging settings with standard pulmonary function tests performed in these patients/volunteers. For testing the reproducibility of the visual defect score of (81m)Kr scintigraphy additionally 13 patients suspected for pulmonary embolism or lung cancer were included. Each series of planar or SPECT studies were read for the extent (% abnormal lung) and severity (0-3) of ventilation abnormalities. Seventeen scans were read twice for reproducibility studies. The extent of ventilation defect assessed by (81m)Kr SPECT was higher than by (81m)Kr planar (slope of regression line 0.60, P<0.0001), likewise severity score (rank signed test: P<0.0001). Correlation between ventilation inhomogeneity and pulmonary function test (residual volume and T(L,CO)) in the COPD group revealed only significance for the SPECT acquisition. We found good reproducibility of visual assessment of ventilation defect extent (correlation: 0.97, P<0.0001) and severity (Kappa 0.62). In conclusion, visual scoring of extent and severity of ventilation defects was reproducible. Ventilation defects were better demonstrated with SPECT than planar imaging. The correlation to pulmonary function was better with SPECT than planar imaging.     

Diagnostic evaluation of planar and tomographic ventilation/perfusion lung images in patients with suspected pulmonary emboli

Planar lung ventilation/perfusion scintigraphy (V/P(PLANAR)) is a standard method for diagnosis of pulmonary embolism (PE). The goals of this study were to test whether the diagnostic information of ventilation/perfusion tomography (V/P(SPET)) applied in clinical routine might enhance information compared with V/P(PLANAR) and to streamline data processing for the demands of clinical routine. This prospective study includes 53 patients suspected for PE referred for lung scintigraphy. After inhalation of (99m)Tc-DTPA planar ventilation imaging was followed by tomography, using a dual-head gamma camera. (99m)Tc-MAA was injected i.v. for perfusion tomography followed by planar imaging. Patients were examined in supine position, unchanged during V/P tomography. Two reviewers evaluated V/P(PLANAR) and V/P(SPET) images separately and randomly. Mismatch points were calculated on the basis of extension of perfusion defects with preserved ventilation. Patients were followed up clinically for at least 6 months. With V/P(SPET) the number of patients with PE was higher and 53% more mismatch points were found. In V/P(SPET) interobserver variation was less compared with V/P(PLANAR). Ancillary findings were observed by both techniques in half of the patients but more precisely interpreted with V/P(SPET). V/P(SPET) shows more and better delineated mismatch defects, improved quantification and less interobserver variation compared with V/P(PLANAR). V/P(SPET) is amenable to implementation for clinical routine and suitable even when there is demand for a high patient throughput.     

Comparison of ventilation/perfusion scintigraphy and helical CT for diagnosis of pulmonary embolism; strategy using clinical data and ancillary findings

Study objective: To address the question whether ventilation/perfusion scintigraphy (SCINT) or helical computed tomography (CT) should be the first hand method for diagnosis of pulmonary embolism (PE). Setting: Departments of radiology, nuclear medicine and internal medicine of a large university hospital. Patients: During 3 years all 128 patients examined for PE with both methods were analysed. The strategy of interpretation behind original clinical reports, i.e. clinical CT and clinical SCINT, was based upon basic criteria for PE, ancillary findings and information from the referring doctor and from previous examinations. Reviewed SCINT and CT reports were obtained from experts in each field blinded to clinical and laboratory data. The findings with respect to PE were classified as no PE, PE or non‐diagnostic. Other pathology than PE was described. A final diagnosis serving as reference was based upon CT, SCINT and other information including clinical follow for 6–24 months. Methods: Planar SCINT was made with ventilation always preceding perfusion. CT was made with contrast injection using 3 mm collimation and table feed of 3 mm s^?1. Results: PE was diagnosed in 32 patients. For clinical and reviewed SCINT sensitivity was 91 and 97%, specificity 96 and 100% and rate of non‐diagnostic findings 10 and 9%, respectively. For clinical and reviewed CT sensitivity was 81 and 78%, specificity 99 and 100% and non‐diagnostic findings was observed in 8 and 1%, respectively. In patients with PE, concordant positive results were obtained with both modalities in 23 of 32 patients (72%). Conclusion: SCINT remains the first hand method because its high sensitivity, general feasibility, low radiation burden and low rate of non‐diagnostic findings in our setting. CT is indispensable when SCINT is not available or its result non‐diagnostic.     

去甲乌药碱负荷心肌灌注显像评价冠心病心肌血供

目的 评价盐酸去甲乌药碱（HG）负荷核素心肌灌注显像（MPI）对冠心病（CHD）的诊断价值。方法 对65例入选患者采用交叉试验法分别先后给予HG注射液（HG组）和安慰剂注射液（安慰剂组）的负荷试验,行负荷-静息^99mTc-MIBI MPI检查,以CAG结果为金标准,计算HG负荷显像诊断CHD的灵敏度、特异度、准确率、阳性预测值和阴性预测值。结果 HG注射液心脏负荷试验MPI诊断CHD的灵敏度为69.57%（16/23）、特异度为97.62%（41/42）、准确率为87.69%（57/65）、阳性预测值为94.12%（16/17）、阴性预测值为85.42%（41/48）。在HG负荷试验中,63例患者出现不同程度的不良反应,表现为心悸（57例）、胸闷（17例）、头晕（1例）、胸痛（10例）等,症状较轻微,停药后10 min内自行缓解。结论 HG作为心脏负荷试验药物用于MPI诊断CHD,具有较好的诊断效能,其不良反应轻微,安全可行,有望成为一种新型的心脏负荷试验药物。     

Effects of lung volume reduction surgery on distribution of ventilation and perfusion

Lung volume reduction surgery (LVRS) results in functional improvements in most patients. The mechanisms behind the improvements are not clear. We hypothesized that reduced inequalities in ventilation to perfusion ratio (V/Q) may be a contributing explanation. Nine patients who underwent LVRS were investigated by ventilation and perfusion scintigrams before and after surgery. In addition, 8 healthy subjects were investigated once. The relative ventilation, perfusion and V/Q were calculated in 1 x 1 cm lung elements. Normal range of the element count-rate was determined by the corresponding results in the normal subjects. Results of this small study show a significant effect of LVRS on V/Q, with reduction of shunt-like elements. We conclude that the functional improvement after LVRS to some extent may be explained by decreased V/Q inequality.     

老年慢性阻塞性肺疾病患者胸腔镜手术中肺保护性通气策略的临床价值

目的 观察老年慢性阻塞性肺疾病(简称慢阻肺)患者胸腔镜术中应用肺保护性通气策略对围术期并发症、肺氧合水平及血清炎症因子表达的影响效果.方法 选取老年慢阻肺患者112例作为研究对象,患者均接受全凭静脉麻醉和胸腔镜手术,将其随机分为对照组和观察组,每组56例.对照组采用常规肺通气策略(潮气量8-10 mL/kg),观察组采...     

99Tcm-MAA动态-全身-局部肺灌注显像对原因不明呼吸困难的诊断价值

目的 探讨⁹⁹Tc^m-MAA动态-全身-局部肺灌注显像对原因不明呼吸困难的诊断价值。方法 收集因原因不明呼吸困难行⁹⁹Tc^m-MAA动态-全身-局部肺灌注显像的19例患者,以出院诊断为标准,分析患者显像结果。结果 共13例患者确诊为肺内分流,其中9例患者诊断为肝肺综合征,另4例患者包括1例遗传性毛细血管扩张症、3例肺内分流原因未明。所有患者均排除肺栓塞。结论 ⁹⁹Tc^m-MAA动态-全身-局部肺灌注显像,可同时诊断或排除肺内分流及肺栓塞,可在临床推广使用。     

不同浓度氧通气对先天性心脏病患儿体外循环肺功能的影响

目的观察先天性心脏病（先心）患儿体外循环（CPB）前后采用不同浓度的氧通气对术后肺功能恢复的影响。方法 30例择期手术的非紫绀型先心患儿,随机分为两组。H组：100%FiO2组（n=15）;L组50%FiO2组（n=15）。H组CPB前后CPB再灌注期开始后应用100%氧气机械通气,L组相应时间应用50%氧气机械通气。于CPB前,CPB后1、6 h同步抽取桡动脉、肺动脉混合静脉血做血气分析,并根据公式计算出氧合指数（PaO2/FiO2）、呼吸指数（RI）、肺内分流率（Qs/Qt）,同时抽取静脉血检测氧化物歧化酶（SOD）、丙二醛（MDA）。结果两组患儿PaO2/FiO2在CPB后1h均较CPB前降低（P〈0.05）,CPB后6 h,L组的氧合指数恢复至CPB前水平,但H组仍明显低于CPB前（P〈0.05）,且低于同时点的L组（P〈0.05）。在CPB后1 h,H组患儿的RI、Qs/Qt明显高于CPB前（P〈0.05）,且高于同时间点的L组患儿。CPB后1 h两组患儿血浆SOD活性均下降,MDA产生增加,H组SOD消耗较多（P〈0.05）,MDA含量高于L组（P〈0.05）。结论先心患儿体外循环手术中予以50%氧气通气,能够减轻缺血再灌注氧自由基损伤,有利于改善肺的氧合功能。     

Impact of SPECT myocardial perfusion imaging on cardiac care

Single photon emission computed tomography myocardial perfusion imaging is a powerful modality for the assessment of coronary artery disease. It is useful in the diagnosis of CAD, prognostication of CAD and the determination of viability. It acts as guide for therapy and has the ability to assess effectiveness of therapy. The use of SPECT myocardial perfusion imaging has also been shown to be cost–effective compared to other modalities in cardiology.