核素肺通气/灌注显像在肺动脉血栓栓塞症中的应用

目的 应用肺通气／灌注（V／Q）显像研究下肢深静脉血栓（DVT）患者肺栓塞（PE）发病情况，并与CT血管造影（CTA）或MR血管造影（MRA）结果进行比较。方法 85例DVT患者进行肺通气（Technegas）／^99Tc^m-聚合白蛋白（MAA）灌注显像和X线胸片检查，其中13例同期进行肺CTA或MRA检查。根据PIOPED诊断标准（1995年修正版），综合分析肺V／Q显像和X线胸片结果，划分为PE高、中、低、极低度可能性和正常5类，并以低、中和高度PE可能性者为阳性，极低可能性和正常者为阴性。结果 85例患者中，PE高度可能性34.1％，中度可能性8．2％，低度可能性7．1％，极低度可能性1．2％，正常49．4％，共计阳性率49．4％，阴性率50．6％。13例同期进行CTA或MRA检查的患者中，3例V／Q显像和CTA或MRA发现病灶数量和范围一致，10例不一致。肺动脉部分栓塞时，由于血流可通过，肺组织灌注可能正常，V／Q显像往往不能发现病变血管。而外周肺段、亚分段较小肺动脉栓塞时，CTA或MRA容易漏诊。结论 V／Q显像可以提供优良、准确的PE诊断结果，CTA检查与其可优势互补。

Applications of lung 99Tcm-Technegas/99Tcm-MAA lung scan in patients with pulmonary thromboembolism

Objective The existence and severity of pulmonary thromboembolism(PTE)was still one of the Major clinical concerns.The aim of this study was to assess the use of lung ventilation/perfusion (V/Q)scan in the investigation of PTE in light of CT angiography(CTA)or MR angiography(MRA). Methods A total of 85 patients with deep venous thrombosis(DVT)underwent V/Q planar scan and chest X-ray.The modified Prospective Investigation of Pulmonary Embolism Diagnosis(PIOPED)diagnostic crite- rion was used for interpretation of lung scintigraphy.In 13 patients,CTA or MRA were also performed.Re- sults In 85 patients,34.1% was found in high risk of PTE by lung V/Q scan,mid and low risk in 8.2% and 7.1% respectively.In 13 patients underwent both lung V/Q scan and CTA or MRA examination,10 pa- tients showed different findings between lung V/Q scan defect and CTA or MRA blood vessel abnormality. Conclusions Lung V/Q scan was a considerably effective technique to detect PTE.The combination of V/Q scan and CTA or MRA could provide more comprehensive and accurate diagnostic information.