肺通气?蛐灌注显像与螺旋CT血管成像用于肺栓塞诊断的比较研究

目的:比较通气?蛐灌注(V-P)显像和螺旋CT血管成像(SCTA)对肺栓塞(PE)诊断的临床价值。资料和方法:65例疑有PE的患者同时进行了V-P显像和SCTA检查,包括29例PE和36例非PE患者。以最终临床诊断为标准,分别评价两种显像对PE诊断的临床价值。结果:V-P显像对PE诊断的灵敏度、特异性和准确性分别为86.2%,72.2%和78.5%,SCTA分别为79.3%,91.7%和86.2%。非确定性诊断在V-P显像中占受检病例的16.9%,SCTA占4.6%。V-P显像的非确定性诊断多出现于既往有其它心肺疾患的患者,如将非确定性诊断病例去除,则V-P显像的各项诊断参数均较SCTA呈增高趋势。联合应用两种检查法,则诊断的灵敏度、特异性和准确性分别可提高到93.1%,94.4%和93.8%。结论:总体上SCTA对PE诊断的准确性优于V-P显像,应作为首选检查法;如果对受检病例作适当的选择,V-P显像的诊断价值仍有可能进一步提高;联合应用两种显像是目前最为理想的PE诊断方法。

Clinical evaluation of ventilation-perfusion scintigraphy and spiral CT angiography in the diagnosis of pulmonary embolism

Objective: To evaluate the clinical capability of ventilation-perfusion(V-P) scintigraphy and spiral CT angiography(SCTA) in the diagnosis of pulmonary embolism(PE). Methods: Sixty-five patients with suspected PE underwent V-P scintigraphy and SCTA. Sensitivity, specificity and accuracy for diagnosing PE were calculated for V-P scintigrams and SCTA scans, comparing with the final clinical diagnosis. Results: The sensitivity for detection of PE with V-P scintigraphy and SCTA was 86.2% and 79.3%, respectively, and the specificity was 72.2% and 91.7%, respectively. The accuracy of SCTA(86.2%) was significantly higher than that of V-P scintigraphy(78.5%)(P=0.01). Non-diagnostic result was found in 16.9% of the subjects on V-P scintigraphy, and 4.6% on SCTA. Non-diagnostic results on V-P scintigraphy were usually seen in those patients who had heart or other pulmonary disorder. If the non-diagnostic results were excluded, the diagnostic specificity and accuracy of V-P scintigraphy tend to be better than that of SCTA. By combining V-P scintigraphy and SCTA, the sensitivity, specificity and accuracy were improved to 93.1%, 94.4% and 93.8%, respectively. Conclusion: SCTA is more accurate in the diagnostic procedure of PE comparing with the V-P scintigraphy, and should be the first choice. However, V-P scintigraphy still is a promising method if the subjects were selected properly. The combination of V-P scintigraphy and SCTA will be most accurate.