核素显像对疑肺栓塞患者诊断的对比性研究

目的 研究核素下肢静脉造影和肺灌注／通气显像对肺栓塞(PE)的诊断、治疗及预后的评价．方法 3l例怀疑深静脉血栓形成(DET)患者行核素下肢静脉造影、肺灌注／肺通气显像；l例行核素上腔静脉造影；2例行核素下腔静脉造影．与高速螺旋CT、彩超、X线胸片结果对比进行评价．结果 核素下肢静脉造影阳性20／31例．其中肺灌注／通气显像不匹配高度可能者诊断为PE4／20例．伴急性PE症状者2／4例，在24小时内行溶栓治疗后，症状消失，肺灌注像恢复正常．2／4例治疗后肺灌注显像持续未恢复患者，3年随访肺灌注显像持续缺损与通气不匹配，出现肺动脉高压、肺原性心脏病．3／20例在1年随访中先后发生PE．2例肿瘤患者下腔静脉造影发现癌栓阻塞．8例下肢静脉造影和肺灌注／通气显像正常的低概率病人，追踪4个月未发现PE．结论 肺灌注／通气显像对PE的诊断及高危人群的预测及疗效观察有价值．

Clinical Evaluation of Nuclear Medicine Imaging in Diagnostic Approaches Pulmonary Embolism

Objective To search of nuclein lower extremity phlebography & perfusion/ventilation imaging refer to the diagnostic, the treatment & the evaluation of prognosis. Methods 31 suspect patients of deep veins of lower limb thrombosis were performed nuclein venous thrombosis of lower extremity phlebography & perfusion/ventilation imaging; 1 of 3 cancer patients was performed nuclein superior venacavography & 2 of them were performed nuclein inferior venacavography. Comparing to the results of high-speed spirals CT, color Doppler, X-ray thoracic radiography. Results 20/31 patients nuclein venous thrombosis of lower extremity phlebography are masculine. Among 4/20 patients with high opportunity uncoupling perfusion/ventilation imaging was diagnosed as PE. 2/4 patients with acute pulmonary embolism were performed thrombolysis treatment within 24 hours, the symptom was extinct, the perfusion imaging was reversed normally. 2/4 patients with acute pulmonary embolism that perfusion imaging were not reversion after treating with acute pulmonary embolism and the perfusion imaging continuous defect with ventilation uncoupling during 3 years, was diagnosed pulmonary hypertension and cor pulmonale. 2 patients with cancer was detected cancer embolism after inferior venacavography. 8 patients with lesion in veins of lower extremity was not occur pulmonary embolism that the perfusion/ventilation imaging was normally and low probabilistic. Conclusions The perfusion/ventilation imaging is available for the diagnosis of PE and the predict, the observing effect of high-risk group.