肺气/灌注显像与螺旋CT诊断肺栓塞的对比分析

目的比较肺通气／灌注(Lung perfusion／ventilation scintigraphy．Q／V)显像与螺旋CT肺动脉造影(Computerized tomography pulmonary angiography．CTPA)在肺栓塞(Pulmonary embolism，PE)定性及定位诊断对治疗决策的影响、溶栓及抗凝治疗后的疗效观察等方面的临床价值。方法回顾性分析了23例PE患者的肺Q/V显像(35例次)，并与CTPA(31例次)结果进行对比分析。结果肺Q／V与CTPA定性诊断符合率91．3％；定位诊断符合率53．37％；治疗前肺Q/V提示大面积肺栓塞的4例急性PE患者行溶栓治疗．1例CTPA提示大面积肺栓塞的急性PE患者行溶栓治疗：PE患者溶栓治疗后4例复查肺Q/V及2例复查CTPA、抗凝治疗后3例复查肺Q/V及2例复查CTPA结果显示受累肺段的改善情况与溶栓治疗疗效、与患者症状改善相一致。结论肺Q/V与CTPA定性诊断PE有很好的一致性。但定位方面存在差异．CTPA与肺Q/V存在互补关系。但尚无法取代肺Q/V显像。

Compare lung ventilation/perfusion scintigraphy with spiral CT pulmonary angiography for diagnosis of pulmonary embolism

Objective To compare lung perfusion/ventilation scintigraphy (Q/V) with spiral CT pulmonary angiography (CTPA) for diagnosis and localization of pulmonary emboli (PE) and impact on therapitic methods and effect after thrombolysis in patients. Methods We analysed the results of Q/V scintigraphy (35 cases) in 23 patients with PE retrospectively, which were compared to those of CTPA (31 cases). Results The findings of Q/V and CTPA were both positive in 23 patients (91.3%). 53.37% of abnormal segments in two means were equivalent. Q/V showed a large acute PE in 4 patients before therapy, but 1 patient for CTPA, and they all received thrombolysis. Q/V was repeated in 4 patients and CTPA in 2 patients after thrombolysis. After anticoagulant therapy Q/V or CTPA was repeated in 3 and 2 cases respectively. The improvement of abnormal segments in Q/V and CTPA was equivalent to that of symptom and therapitic effect. Conclusion Q/V is consistent with CTPA for diagnosis of PE. They are discrepant in localization of PE and complemented. CTPA could't replace Q/V entirely.