^99mTc-MAA显像、X线片、超声、CT和PA诊断肺栓塞的研究

目的对比研究^99mTc-MAA显像、X线片、超声、CT和肺动脉造影（PA）对下肢创伤及手术后（LEPP）患者并发肺栓塞（PE）的诊断价值。方法16例LEPP临床疑为PE的患者同期行^99mTc-MAA肺血流灌注显像（PPI）、下肢深静脉显像（RNVI）、X线胸片、胸部和下肢超声、胸部CT、PA检查。以PA为标准，计算PPI、X线片、超声、CT诊断PE的灵敏度。结果①16例患者中PA证实14例为PE，其中左侧PE3例，右侧PE7例，双侧PE4例，排除PE2例；②PPI发现14例PE受累肺段168个，平均每例受累11．8±4．6（3～17）肺段；③PPI、X线片、超声、CT诊断PE的灵敏度分别为100％（14／14）、28．6％（4／14）、35．7％（5／14）、85．7％（11／14）；④RNVI发现71．4％（10／14）的PE有下肢深静脉血栓（DVT），超声提示78．6％（11／14）的PE有DVT（χ^2=0．19，P〉0．05）。结论^99mTc-MAA显像为准确、无创、经济地诊断LEPP并发DVT和PE的影像学方法。

Comparative study on the results of diagnosis of pulmonary embolism with ^99m TC - MAA imaging, X - ray, ultrasound, CT and PA.

Objective To assess the diagnosis value of pulmonary embolism（PE） with ^99mTc - MAA imaging, X - ray, ultrasonography, CT and pulmonary angiography （PA） in lower extremital posttraumatosis and postoperation （LEPP） patients. Methods There 16 LEPP patients with clinical suspected PE underwent pulmonary perfusion imaging（PPI）, radionuclide veins imaging（RNVI）, X - ray, ultrasonography, CT and PA simultaneously. Results （1） 14 of 16 patients were confirmed to be with PE by PA. Pulmonary artery embolism on beth sides was observed in 4 cases, 3 on the left and 7 on the right.（2） 168 multiple segment perfusion （11. 8 ± 4. 6） defects were obsreved inl4 PE by PPI. （3） The diagnostic sensitivity of PPI, X- ray, ultrasonography, CT was 100% ,28.6% ,35.7% and 85.7% , respectively. （4）10 of 14 PE（71.4% ） was confirmed to be with deep veins thrombosis（DVT） by RNVI, 11 among the 14 PE（78.6%） with DVT by ultrasonography （χ^2 = 0.19, P 〉 0.05）. Conclusion ^99mTc - MAA imaging is the most effective and noninvasive method for diagnosing PE and DVT complication of LEPP patients.in comarision with X- ray, ultrasonography, CT and PA.