摘要
目的探讨肺通气/灌注(V/Q)平面显像、肺V/Q SPECT/CT显像、CT肺动脉造影(CTPA)对肺栓塞的临床诊断价值。方法回顾性分析2016年10月至2018年6月北部战区总医院临床疑诊肺栓塞的54例患者[男27例,女27例,年龄(62.0±12.8)岁]。患者均行V/Q平面显像、V/Q SPECT/CT显像和CTPA,对三者结果分别按修订后的肺栓塞诊断的前瞻性研究Ⅱ(PIOPEDⅡ)标准、2009年欧洲核医学学会(EANM)制定的诊断标准、肺栓塞诊断的直接征象和间接征象判别,分为肺栓塞、非肺栓塞和不确定诊断。以临床最终诊断为依据,绘制受试者工作特征(ROC)曲线,计算比较各自曲线下面积(AUC),评价3种检查方法对肺栓塞的诊断价值。采用Kruskal-Wallis检验分析3种方法检出的肺段数及亚肺段数,两两比较采用Wilcoxon秩和检验。结果54例患者中,临床最终确诊PE 26例,排除28例。V/Q平面显像、V/Q SPECT/CT显像和CTPA不确定诊断分别有5、1和4例;三者诊断肺栓塞的灵敏度、特异性、准确性、阳性预测值、阴性预测值分别为66.67%(16/24)、88.00%(22/25)、77.55%(38/49)、16/19、73.33%(22/30);92.31%(24/26)、92.59%(25/27)、92.45%(49/53)、92.31%(24/26)、92.59%(25/27);69.57%(16/23)、96.30%(26/27)、84.00%(42/50)、16/17、78.79%(26/33);三者AUC分别为0.757、0.926和0.809,仅V/Q平面显像与V/Q SPECT/CT显像AUC比较差异有统计学意义(z=2.641,P<0.05)。V/Q平面显像、V/Q SPECT/CT显像和CTPA检出的肺段数差异无统计学意义(H=1.637,P>0.05);三者检出的亚肺段数分别为2.00(0.00,5.25), 4.00(2.75,7.00),0.50(0.00,3.25),V/Q SPECT/CT显像可检出更多的亚肺段(z值:-3.700和-3.570,均P<0.05)。结论V/Q SPECT/CT显像可有效提示肺段尤其是亚肺段发生肺栓塞的可能性,值得临床推广。
Objective To study the diagnostic values of pulmonary ventilation-perfusion (V/Q) planar imaging, pulmonary ventilation/perfusion SPECT/CT (V/Q SPECT/CT) imaging and CT pulmonary angiography (CTPA) for pulmonary embolism (PE). Methods From October 2016 to June 2018, 54 patients (27 males, 27 females, age:(62.0±12.8) years) with suspected PE underwent V/Q planar imaging, V/Q SPECT/CT imaging and CTPA in the General Hospital of Northern Theater Command. The results of the above imaging methods were classified as definite PE, no PE and uncertain diagnosis according to the refined modified prospective investigation of pulmonary embolism diagnosis (PIOPEDⅡ) criteria, European Association of Nuclear Medicine (EANM) diagnosis criteria (2009) and the direct and indirect signs of PE, respectively. Based on the final clinical diagnosis, receiver operating characteristic (ROC) curves were drawn and the area under curves (AUCs) were compared to assess the diagnostic efficacies for PE. Kruskal-Wallis test and Wilcoxon rank sum test were used to analyze the difference of pulmonary segment and subsegment number detected by the above methods. Results Among 54 patients, 26 were definitely diagnosed as PE, and 28 were excluded. Patient numbers of uncertain diagnosis in V/Q planar imaging, V/Q SPECT/CT imaging and CTPA were 5, 1 and 4, respectively. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of the above imaging methods were 66.67%(16/24), 88.00%(22/25), 77.55%(38/49), 16/19, 73.33%(22/30);92.31%(24/26), 92.59%(25/27), 92.45%(49/53), 92.31%(24/26), 92.59%(25/27);69.57%(16/23), 96.30%(26/27), 84.00%(42/50), 16/17, 78.79%(26/33), respectively. The AUCs were 0.757, 0.926, and 0.809, respectively, there was a significant difference between the AUC of V/Q planar imaging and V/Q SPECT/CT (z=2.641, P<0.05). There was no significant difference of cumulative number of pulmonary segments detected by the three methods (H=1.637, P>0.05). Numbers of subsegments detected by V/Q planar imagi
作者
安秀香
郭佳
张国旭
An Xiuxiang;Guo Jia;Zhang Guoxu(Postgraduate Training Base of Jinzhou Medical University, General Hospital of Northern Theater Command of Chinese PLA, Shenyang 110016, China;Department of Nuclear Medicine, General Hospital of Northern Theater Command, Shenyang 110016, China)
出处
《中华核医学与分子影像杂志》
CAS
北大核心
2019年第5期278-282,共5页
Chinese Journal of Nuclear Medicine and Molecular Imaging
