论文部分内容阅读
目的比较肺通气/灌注(V/Q)显像与多层螺旋CT肺动脉造影(CTPA)在诊断急性肺动脉血栓栓塞症(PTE)方面的临床价值。方法前瞻性分析2005年10月～2006年5月共51例临床疑诊急性PTE患者的肺灌注显像,其中18例行肺通气显像,并与CTPA对比。以汇总所有临床资料、各实验室检查及影像学检查后讨论得出的最终诊断作为“标准”。结果最终24位患者被诊断为PTE占47．1%(24/51例),V/Q显像与CTPA的灵敏度分别为95．8%(23/24例)和95．8% (23/24例),特异性分别为88．9%(24/27例)和92．6%(25/27例),准确性分别为92．2%(47/51例)和94．1%(48/51例)。在定性诊断方面,2种影像学检查结果差异无统计学意义(X~2=0．14,P= 0．71),两者定性诊断符合率为86．3%(44/51例),Kappa值为0．73。24例PTE患者中,CTPA显示为“完全阻塞”的肺动脉血管所对应的44个肺段中,肺灌注显像显示为“放射性稀疏、缺损”的肺段数为32个(72．7%);CTPA显示为“部分充盈缺损”的肺动脉血管所对应的266个肺段中,肺灌注显像显示为“放射性稀疏、缺损”的肺段数为155个(58．3%),显示为“亚肺段放射性稀疏、缺损”的肺段数为9个(3．4%)。结论V/Q显像与CTPA在PTE定性诊断方面符合率高,一致性好,但在定位方面存在差异;两者为互补关系。
Objective To compare the clinical value of pulmonary ventilation / perfusion (V / Q) imaging and multislice spiral CT pulmonary angiography (CTPA) in the diagnosis of acute pulmonary thromboembolism (PTE). Methods A prospective analysis of lung perfusion imaging in 51 patients with suspected acute PTE from October 2005 to May 2006 was performed. Among them, pulmonary perfusion imaging was performed in 18 patients and compared with CTPA. The final diagnosis, based on a summary of all clinical data, the various laboratory tests and post-imaging examinations, was used as a “standard.” Results The final 24 patients were diagnosed as PTE accounting for 47.1% (24/51 cases). The sensitivity of V / Q imaging and CTPA were 95.8% (23/24 cases) and 95.8% (23 / 24 cases), the specificity was 88.9% (24/27 cases) and 92.6% (25/27 cases) respectively, the accuracy was 92.2% (47/51 cases) and 94.1% 48/51 cases). There was no significant difference between the two kinds of imaging findings in the qualitative diagnosis (X ~ 2 = 0.14, P = 0.71). The coincidence rate of qualitative diagnosis between the two methods was 86.3% (44/51 cases) Kappa value was 0.73. Among the 44 segments of pulmonary arteries corresponding to CTPA that showed “complete obstruction” among 32 PTE patients, there were 32 lung segments with “radioactive sparseness and defect” in lung perfusion imaging (72.7%). Of the 266 lung segments corresponding to pulmonary vessels with CTPA “partial filling defect”, 155 (58.3%) had lung perfusion scintigraphy with “sparse radioactivity” ), The number of segments of the lung that appeared as “sparsely segmental subfractions and defects” was 9 (3.4%). Conclusion V / Q imaging and CTPA have high coincidence rate and consistency in the qualitative diagnosis of PTE, but there are differences in localization; the two are complementary.