肺灌注SPECT/CT对恶性肿瘤患者肺栓塞诊断价值

目的：回顾性研究肺灌注SPECT/CT对可疑肺栓塞（PTE）的恶性肿瘤患者的诊断价值。方法：回顾性分析2011年7月1日—2013年12月1日于我科进行肺灌注SPECT/CT显像可疑PTE的恶性肿瘤患者55例。回顾性分析患者肺灌注SPECT/CT图像。SPECT/CT栓塞肺段判断标准：沿肺段或亚肺段分布的楔形或片状放射性稀疏或缺损区,CT图像上相应部位无其他导致肺段血流灌注减低的病变。综合患者临床资料作出有无PTE的最终诊断。计算恶性肿瘤患者经肺灌注SPECT/CT诊断PTE的灵敏度、特异性、阳性预测值、阴性预测值、准确性。对恶性肿瘤患者肺灌注SPECT/CT诊断结果与综合患者临床资料诊断结果,进行配对四格表χ^2检验（McNemar检验）。结果：55例恶性肿瘤患者肺灌注SPECT/CT诊断为PTE 42例,经综合临床资料诊断为PTE 40例,与肺灌注SPECT/CT诊断结果差异无统计学意义（P=1）。恶性肿瘤患者经肺灌注SPECT/CT诊断PTE的灵敏度为95.1%,特异性为78.6%,阳性预测值为92.9%,阴性预测值为84.6%,准确性为90.9%。结论：肺灌注SPECT/CT能够较准确的诊断恶性肿瘤患者的PTE,为恶性肿瘤患者提供了一种可靠的PTE诊断方法。

The diagnostic value of the pulmonary perfusion SPECT/CT in detecting pulmonary embolism for patients due to malignant tumor

Objective： To retrospectively study the diagnostic value of pulmonary perfusion SPECT/CT in patients suspected of having pulmonary embolism due to malignant tumor. Methods： All the 55 patients suspected of having pulmonary embolism due to malignancy received pulmonary perfusion SPECT/CT in our department from July 1, 2011 to December 1, 2013. The pulmonary perfusion SPECT/CT images were analyzed retrospectively. The standard for diagnosing embolism lung segment were sparse or defective radioactive distribution in a wedge shape lung segment or sub-segment, but no lesions that caused lung perfusion reduced in the corresponding lung on CT images. The final diagnosis of pulmonary thromboembolism（PTE） was confirmed by comprehensive analysis of the patients＇ clinical data. The positive rate, sensitivity, specificity, positive predictive value, negative predictive value and accuracy of lung perfusion SPECT/CT in the diagnosis of PTE were calculated. The datas diagnosed by lung perfusion SPECT/CT and by comprehensive analysis of the patients＇ clinical data were analyzed by matching four-fold table chi-square test（McNemar test）. Results： Among the 55 patients with malignant tumor, 42 cases were diagnosed PTE by pulmonary perfusion SPECT/CT, and 41 cases were diagnosed PTE by comprehensive analysis of the patients＇ clinical data. There was no statistical difference of the results diagnosed by pulmonary perfusion SPECT/CT and by comprehensive analysis of the patients＇ clinical data（χ^2=0.049, P0.05）. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of lung perfusion SPECT/CT in the diagnosis PTE was 94.4%, 85.2%, 89.5%, 92.0%, 90.5%respectively. Conclusion： PTE in patients with malignant tumor can be accurately diagnosed by pulmonary perfusion SPECT/CT which provides a reliable method for diagnosis.