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。     

67-Ga显像对肺部良、恶性病变鉴别诊断的临床价值

目的探讨67Ga平面显像与断层显像对肺癌及肺部良性疾病鉴别诊断的临床应用价值.方法对251例胸部X线或CT检查怀疑为肺癌的患者进行67Ga胸部平面显像,其中105例另行67Ga胸部断层显像.肺癌诊断全部由组织病理学检查确定;良性病变的诊断由病理、实验室检查及临床转归等确定.结果 67Ga平面显像对肺癌诊断的灵敏度、特异性和准确性分别为65%、85%和73%;而67Ga断层显像对肺癌诊断的灵敏度、特异性和准确性分别为82%、84%和83%.良性病变中,肺结核(假阳性率为26%)是导致67Ga显像假阳性的主要原因.结论 67Ga显像对肺部病变的良恶性鉴别诊断是一简便、可行的方法.67Ga断层显像比平面显像对肺癌诊断具有更高的灵敏度和准确性.     

99Tcm-octreotide显像对乳腺癌诊断的初步临床应用

目的 探讨用99锝m-奥曲肽(99Tcm-octreotide)显像对乳腺癌诊断的临床应用价值。方法 选择21例临床拟诊乳腺癌患者术前进行乳腺99Tcm-octreotide显像及B超检查,并与术后病理诊断对照分析。乳腺内或/和腋窝淋巴区域内见局部异常放射性浓聚为99Tcm-octreotide显像阳性。结果 21例患者中16例手术证实为乳腺癌,5例为良性病变。99Tcm-octreotide显像诊断乳腺癌的灵敏度、特异性和准确性分别为93.8%、80.0%和90.5%,其诊断特异性明显高于B超检查(P<0.01),但灵敏度和准确性二种方法无显著性差异(P>0.05)。结论 99Tcm-octreotide显像在乳腺癌的诊断中具有较高的准确性,对于乳腺肿瘤手术方案的制定也有一定的临床应用价值。     

肺肿瘤~(99m)Tc-MDP显像与肿瘤标志物的对比研究

目的探讨99mTc-亚甲基二磷酸盐(MDP)SPECT显像和肿瘤标志物(TM)检查诊断肺癌的临床价值。方法对63例经病理证实的肺肿瘤患者和10例正常对照者进行早期(5 min)MDP显像和TM(CEA、CA125、NSE)检查,以病理为标准比较分析诊断效能。结果肺癌对99mTc-MDP的摄取明显高于良性病灶和正常对照,以摄取比值1.8为判断标准,99mTc-MDP显像诊断肺癌的灵敏度和特异性分别为84.3%和81.8%;CEA、CA125、NSE测定的灵敏度和特异性分别为72.1%、68.2%、62.7%和62.1%、49.0%、82.3%;MDP显像和联合TM诊断肺癌的灵敏度和特异性为88.2%和90.9%。结论 MDP显像对肺癌的鉴别诊断有较高的临床价值,与TM结合分析可进一步提高肺癌诊断的准确性。     

^99mTc—MDP早期肺显像诊断肺肿瘤与纤支镜检的对比研究

目的　探讨99m Tc- MDP(亚甲基二磷酸盐 ) SPECT显像 ,诊断肺癌的临床价值。方法　对 6 3例经病理证实的肺肿瘤患者进行早期99m Tc- MDP显像 ,同期进行了纤维支气管镜 (FB)检查。以病理结果为标准 ,比较分析诊断效能。结果　肺癌对 99m Tc- MDP的摄取明显高于良性病灶 ,以摄取比值 >1.8为判断标准 ,MDP显像诊断肺癌的灵敏度和特异性分别为 84 .3%和 83.3% ;FB为 90 .2 %和 91.7%。MDP显像和 FB联合诊断肺癌的灵敏度、特异性分别为 96 .1%和95 .5 %。结论　 MDP显像对肺癌的诊断和鉴别诊断有较高的临床价值 ,与 FB结合分析可进一步提高定性定位诊断肺癌的准确性。     

^99mTc-MDP骨显像联合CT对乳腺癌术后早期随访的临床价值

目的^99mTc-MDP骨显像联合CT对乳腺癌术后早期随访，监测其复发及转移的临床应用价值。方法81例乳腺癌手术化疗后3年内的病人，女性，年龄29—65岁，分别行^99mTc-MDP骨显像、CT显像、计算灵敏度、特异性、准确性。结果81例乳腺癌手术化疗后病人中，经病理检查或临床及其他影像学诊断转移的31例，^99mTc-MDP骨显像诊断骨转移的15例，CT显像诊断复发及转移的病例18例，^99mTc-MDP骨显像对骨转移的灵敏度、特异性、准确性分别为93．8％、90．8％、91．4％，CT显像对复发及转移的灵敏度、特异性、准确性分别为58．1％、88．0％、93．8％、90．8％、91．4％，其对骨转移的灵敏度、特异性、准确性分别为51．2％、91．0％、88．4％。CT联合^99mTc-MDP骨显像诊断复发及转移的灵敏度、特异性、准确性分别为94．3％、90．6％、93．3％。结论CT对乳腺癌术后病人软组织的复发及转移有较高的灵敏度，但对于骨转移病灶不及^99mTc-MDP骨显像敏感。因此，两者联合应用可明显提高乳腺癌术后复发及转移的灵敏度、特异性和准确性，对监测其复发及转移具有重要的临床应用价值。     

门控心肌灌注显像诊断冠心病的临床价值

目的:探讨腺苷负荷99mTc-MIBI门控心肌灌注显像(G-MPI)后室壁运动和增厚率异常对冠心病的诊断价值。方法:对91例确诊或临床疑诊为冠心病患者行静息-腺苷负荷99mTc-MIBI G-MPI和非门控心肌灌注显像(MPI),两周内行冠状动脉造影(CAG),对其结果进行对比分析。结果:MPI诊断冠心病的灵敏度为85.3%,特异性为73.9%,G-MPI诊断冠心病灵敏度为92.6%,特异性为87.0%,结合腺苷负荷后局部室壁运动和增厚率评分可提高G-MPI诊断冠心病的灵敏度和特异性。结论:静息-腺苷负荷99mTc-MIBI G-MPI对冠心病的诊断有较高的灵敏度和特异性。     

螺旋CT肺血管造影联合D-二聚体在肺栓塞诊断中的应用

目的 探讨螺旋CT肺血管造影联合D-二聚体在肺栓塞(PE)诊断中的价值.方法 对85例疑似PE患者进行检查.分别评价螺旋CT肺血管造影、D-二聚体及两者联合检测对PE的诊断价值.结果 螺旋CT肺血管造影诊断PE的灵敏度、特异性分别为 87.8%、95.2%,血浆D-二聚体诊断PE的灵敏度、特异性分别为95.4%、63.7%,两者联合检测的灵敏度、特异性分别提高到88.9%和85.7%.结论 螺旋CT肺血管造影联合D-二聚体可明显提高诊断PE的灵敏度和特异性.     

~(99m)Tc-MIBI肺亲肿瘤显像与肿瘤标志物联合诊断肺部结节良恶性的临床价值

目的探讨99mTc-MIBI肺亲肿瘤显像与肿瘤标志物联合诊断肺部结节良、恶性的临床价值。方法对54例CT发现肺部结节的患者行99mTc-MIBI肺亲肿瘤显像与肿瘤标志物测定(包括NSE、CYFRA21-1,采用放射免疫法测定),分别计算出以上2种方法以及联合应用在诊断肺部结节中的灵敏度、特异性、准确性,通过统计学方法将联合应用后的结果分别与单一方法进行比较分析。结果①两种方法联合使用与单用99mTc-MIBI肺亲肿瘤显像相比,灵敏度、特异性、准确性均提高(P0.05)。②两种方法联合使用与单用肿瘤标志物相比,灵敏度、准确性均提高(P0.05),而特异性比较差异无统计学意义。结论 99mTc-MIBI肺亲肿瘤显像与肿瘤标志物测定两种方法联合使用在肺部结节良、恶性鉴别诊断中的价值要高于单一应用。     

螺旋CT血管造影对肺栓塞的临床诊断价值

目的前瞻性评价螺旋CT血管造影对临床疑诊为肺栓塞的诊断价值。方法对32例临床疑诊为肺栓塞的患者行螺旋CT血管造影(SCTA)及二维或三维重建,所有患者经多种影像检查方法和/或临床治疗随访证实。SCTA扫描参数取层厚3.0,螺距(pitch)1.5,用SmartPrep软件对比剂智能触发技术获得最佳延迟扫描时间。结果32例临床疑诊肺栓塞中,21例肺栓塞共累及肺动脉105支;SCTA确诊了19例,2例5个亚段肺动脉的栓子漏诊。在11例肺栓塞阴性中,SCTA对10例作出了正确诊断:2例肺癌,4例肺炎,1例夹层动脉瘤,3例未见明显异常;另外1例肺动脉肉瘤,SCTA误诊为肺栓塞。SCTA诊断肺栓塞的特异性90.9%,敏感性90.5%,准确性90.6,阳性预测值95.0%,阴性预测值83.3%。结论螺旋CT血管造影无创、快速、敏感性及特异性高,可作为诊断肺栓塞的首选检查方法。     

Computed tomography scan versus ventilation-perfusion lung scan in the detection of pulmonary embolism

This study compared the sensitivity and specificity of computed tomography (CT) scan and ventilation-perfusion (V-P) scan in detecting pulmonary embolism (PE) with pulmonary angiogram (AG) as the reference standard. Following a comprehensive search of the indexed medical literature, CT scan studies related to PE diagnosis were systematically evaluated to select those using AG as the reference standard and meeting specified methodologic criteria. Studies were further grouped by those reporting results for central PE findings only versus central and peripheral PE combined. A composite analysis of data derived from seven selected publications yielded sensitivity and specificity estimates for CT scan in detecting PE, which were statistically compared to the published results of a multi-center study reporting the sensitivity and specificity of the V-P scan with pulmonary AG as the reference standard. The calculated CT scan sensitivity was 77% for central PE only data and 81% for central and peripheral PE combined data, and the CT scan specificity was 91% and 98%, respectively. High-probability V-P scan sensitivity was 41% and specificity 97%; high- and intermediate-probability V-P scans combined yielded sensitivity 83% and specificity 52%. The sensitivity for PE detection was significantly greater for CT scan than for high-probability V-P scan; CT scan sensitivity was equivalent to V-P when high- and intermediate-probability scans were considered together. CT scan specificity for central and peripheral PE combined was equivalent to that of the high-probability V-P scan, but significantly greater than that of high- and intermediate-probability V-P scans considered together. Considering that only a small proportion of patients with suspected PE yield high-probability V-P scan results (which are usually indicative of PE), while as many as one-half of patients may yield intermediate-probability results (which are commonly not useful in PE diagnosis), our results suggest the CT scan may be an appropriate study for use by Emergency Physicians in the clinical evaluation of suspected PE.     

Chinese multi-center study of lung scintigraphy and CT pulmonary angiography for the diagnosis of pulmonary embolism

To evaluate diagnostic value of the PISA-PED and PIOPED II criteria for lung scintigraphy and compare it with CT pulmonary angiography (CTPA) for the detection of pulmonary embolism (PE). Five hundred and forty-four consecutive patients with suspected PE were enrolled. All patients underwent lung ventilation/perfusion (V/P) scan, chest radiography, and CTPA. Two readers used the PIOPED II criteria, and 2 used the PISA-PED criteria for the interpretation of lung scintigraphy. CTPA scans were interpreted by two experienced radiologists. Lung scintigraphy and CTPA were categorized as PE present, absent or non-diagnostic. PE was present in 321 of 544 patients. Using PIOPED II criteria, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 85.1, 82.5, 88.1, and 78.4% respectively for V/P scan. Using PISA-PED criteria, sensitivity, specificity, PPV, and NPV were 86.0, 81.2, 86.8, and 80.1% respectively, and none was non-diagnostic. Sensitivity, specificity, PPV, and NPV were 81.7, 93.4, 94.9, and 77.3%, respectively for CTPA. PISA-PED interpretation has similar diagnostic accuracy to PIOPED II interpretation, does not have non-diagnostic scan, with lower cost and radiation, thus should be considered as a choice for patients with suspected PE.     

Accuracy of single-detector spiral CT in the diagnosis of pulmonary embolism: a prospective multicenter cohort study of consecutive patients with abnormal perfusion scintigraphy.

BACKGROUND: Spiral computed tomography (CT) has emerged as a potentially conclusive diagnostic test to exclude pulmonary embolism (PE) in patients with non-high probability scintigraphy and is already widely used-sometimes as the sole primary diagnostic test in the diagnosis of suspected PE. Its true sensitivity and specificity has, however, not been evaluated previously in a large cohort of consecutive patients. METHODS: In a multicenter prospective study 627 consecutive patients with clinically suspected PE were studied. Patients with normal perfusion scintigraphy were excluded from further analysis. Single-detector spiral CT scanning and ventilation scintigraphy were then performed in all patients to diagnose PE, while pulmonary angiography was performed as the gold standard. The only exceptions were those patients who had both a high-probability VQ scan and a CT scan positive for PE: these patients were considered to have PE and did not undergo additional pulmonary angiography. All imaging tests were read by independent expert panels. RESULTS: Five hundred and seventeen patients were available for complete analysis. The prevalence of PE was 32%. Spiral CT correctly identified 88 of 128 patients with PE, and 92 of 109 patients without PE, for a sensitivity and specificity of 69%[95% confidence interval (CI) 63-75] and 84% (95% CI 80-89), respectively. The sensitivity of spiral CT was 86% (95% CI 80-92) for segmental or larger PE and 21% (95% CI 14-29) in the group of patients with subsegmental PE. CONCLUSION: The overall sensitivity of spiral CT for PE is too low to endorse its use as the sole test to exclude PE. This holds true even if one limits the discussion to patients with larger PE in segmental or larger pulmonary artery branches. We conclude that, in patients with clinically suspected PE and an abnormal perfusion scintigraphy, single-slice detector spiral CT is not sensitive enough to be used as the sole test to exclude PE.     

The Clinical Features of Acute Pulmonary Embolism in Ambulatory Patients

Objective : To identify clinical findings and predisposing conditions associated with acute pulmonary embolism (PE) in ambulatory patients being evaluated for PE.
Methods : A prospective observational study was conducted. A standardized multicomponent data collection form was administered to ambulatory subjects being evaluated for PE. The diagnosis of PE was confirmed or excluded using a combination of scintillation lung scanning, lower-extremity venous Doppler ultrasonography, and selective use of pulmonary angiography.
Results : Data collection was completed for 170 subjects, with 26 (15%) cases of PE. Subjects with PE were significantly older (56 vs 41 years, 99% CI for difference of 15 years [6 to 25 years]), were more likely to report unexplained dyspnea (92% vs 69%. 99% CI for difference of 23% [7% to 40%]), and waited longer after symptom onset to seek medical evaluation (73 vs 36 hours, 99% CI for difference of 37 hours [I1 to 63 hours]). No difference was found for multiple variables commonly associated with PE. Assignment to risk categories was of limited diagnostic utility. For example, low-risk assignment yielded 85% sensitivity, 20% specificity; high-risk assignment: 31% sensitivity, 85% specificity, with diagnostic accuracy below 80% in both categories.
Conclusions : Among outpatients selected for evaluation for PE, further risk stratification demonstrated poor diagnostic utility. Clinical features alone cannot be used to differentiate presence or absence of PE in at-risk ambulatory patients. Key words: pulmonary embolism; diagnosis; outpatient; risk; clinical features.     

门脉循环γ照相与彩色多普勒对肝硬化的诊断意义

为评价门脉循环γ照相与彩色多普勒对肝硬化的诊断效能,18例肝硬化患者15例正常对照同时进行门脉循环γ照相和彩色多普勒扫描。结果表明,肝硬化组门脉分流指数(SI)明显高于对照组(P<0.01).诊断肝硬化灵敏度、特异性和准确性分别为83.3％、100.0％和90.9％。彩色多普勒扫描结果示,肝硬化组平均血液速度显著高于正常人组(P<0.05),两组门脉内径与血流量无显著差异(P>0.05),诊断肝硬化灵敏度、特异性准确性分别为66.6％、60.0％和63.6％。提示门脉循环γ照相对肝硬化化诊断意义,其诊断效能优于彩色多普勒。     

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.     

增强与非增强MR肺动脉血管成像诊断肺栓塞准确性的对比研究

目的比较对比增强MR血管成像(contrast-enhanced MR pulmonary angiography,CE-MRA)与非增强空间标记多反转脉冲序列(applying spatial labeling with multiple inversion pulses sequence,SLEEK)MR血管成像诊断肺栓塞(pulmonary embolism,PE)的准确性。材料与方法 26例CT肺动脉血管成像诊断肺栓塞的患者(男15例,女11例)于多排螺旋CT肺动脉造影(CT pulmonary angiography,CTPA)检查48 h内行CE-MRA以及非增强SLEEK MR检查。CTPA作为参考标准,计算并比较每种MR技术诊断肺栓塞的敏感性、特异性、阳性预测值以及阴性预测值。结果 CE-MRA诊断肺栓塞的敏感性为78.8%,特异性97.7%。非增强SLEEK MRI诊断肺栓塞的敏感性83.8%,特异性100%。两阅片者间存在高度一致性(k=0.87)。结论 CE-MRA和SLEEK MRI诊断肺栓塞的准确性无统计学差异,但非增强SLEEK MRI血管成像无需使用对比剂,有希望成为肺栓塞诊断策略中的一部分。     

The diagnostic role of capnography in pulmonary embolism

The aim of this study was to evaluate the diagnostic contribution of alveolar dead space fraction (AVDSf) measured using capnography in patients admitted with suspected pulmonary embolism (PE). A total of 58 patients who were admitted to our hospital with suspected PE between October 2006 and January 2008 were included in this study. All patients were assessed using the Wells clinical score, capnography, computed tomographic pulmonary angiography, D-dimer measurement, lower-extremity venous Doppler ultrasonography, and V/Q scintigraphy. Forty patients (69%) had PE based on computed tomographic pulmonary angiography findings. The AVDSf value with the highest sensitivity and specificity, which was at the same time statistically significant, was 0.09. This value was consistent with the AVDSf value obtained using receiver operating characteristic analysis. In our study, the sensitivity of capnography was 70%, with a specificity of 61.1%, positive predictive value of 80%, and negative predictive value of 47.8%. The use of AVDSf in combination with any of the several scoring systems that evaluate clinical likelihood of PE and D-dimer levels resulted in higher sensitivity and specificity rates for the diagnosis of PE.     

Diagnosis of pulmonary embolism with use of computed tomographic angiography

Pulmonary embolism (PE) is a common diagnostic problem, particularly in hospitalized patients. It remains a frequent cause of unexpected deaths. Traditionally, the diagnostic work-up for suspected PE has centered on the use of ventilation-perfusion (V-P) radionuclide lung scanning. However, V-P scanning does not provide adequate confirmation or exclusion of the diagnosis in the majority of patients who undergo this test. Although published guidelines advise further diagnostic testing after nondiagnostic V-P scans, clinicians infrequently perform such testing, and management decisions are commonly based on clinical judgment. In recent years, there has been an increasing interest in the use of computed tomographic (CT) angiography in the diagnostic evaluation of patients with suspected PE. Although there are unresolved issues regarding its sensitivity in detecting small peripheral emboli, CT angiography is more accurate than V-P scanning in the diagnosis of PE and yields other intrathoracic diagnoses. Herein we summarize the problems with the traditional approach centered on the use of V-P scanning in the diagnosis of PE and propose an alternative diagnostic strategy based primarily on the use of CT angiography.