肺通气／灌注显像与多层螺旋CT肺动脉造影诊断慢性血栓栓塞性肺动脉高压的前瞻性对比研究  

Diagnosis of chronic thromboembolic pulmonary hypertension： prospective comparison of ventila- tion-perfusion scintigraphy and multidetector CT pulmonary angiography

作　　者：何嘉[1] 方纬[1] 何建国 熊长明 倪新海 柳志红 顾晴 王蒨[3] 赵智慧 何作祥[1] 

机构地区：[1]北京协和医学院、中国医学科学院阜外心血管病医院核医学科,100037 [2]肺血管病诊治中心 [3]首都医科大学附属北京安贞医院核医学科

出　　处：《中华核医学与分子影像杂志》2012年第5期341-344,共4页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：国家科技支撑计划（2006BA101A07）;北京市科技计划（D101100050010034）

摘　　要：目的比较肺V／Q显像与多层螺旋CT肺动脉造影（CTPA）对慢性血栓栓塞性PAH（CTEPH）的诊断效能。方法2006年1月至2010年12月间疑诊为CTEPH的PAH患者133例[男54例、女79例，15～78（43．1±14．9）岁]均在7d内接受肺V／Q显像、CTPA和肺动脉造影检查。以肺动脉造影为“金标准”，评价其他2种方法诊断准确性。V／Q显像结果包括CTEPH高度可能性、中度可能性和低度可能性；CTPA结果包括CTEPH阳性、阴性及不能诊断。应用Kappa检验分析这2种方法诊断结果的一致性。结果其中51例患者被最终确诊为CTEPH（38．3％）；其余82例中，60例诊断为IPAH，19例诊断为肺血管炎，3例为房间隔缺损。以CTEPH高度可能性作为阳性标准时，V／Q显像的诊断灵敏度为96．1％（49／51），特异性为75．6％（62／82），准确性为83．5％（111／133）；以CTEPH高度和中度可能性均作为阳性标准时，V／Q显像的诊断灵敏度为100％（51／51），特异性为73．2％（60／82），准确性为83．5％（111／133）。CTPA的诊断灵敏度为92．2％（47／51），特异性为92．7％（76／82），准确性为92．5％（123／133）。V／Q显像以CTEPH高度可能性作为阳性标准时，V／Q显像与CTPA的诊断符合率为80．5％（107／133），Kappa=0．612，P〈0．001。结论对于CTEPH的诊断，V／Q显像灵敏度较高；而CTPA则特异性较高，且对肺血管炎等其他PAH疾病鉴别力较好。两者结合可能有助于提高对CTEPH诊断的准确性。Objective To compare the diagnostic efficacy of V/Q scintigraphy and CT pulmonary angiography （CTPA） for chronic thromboembolic PAH （CTEPH）. Methods A total of 133 consecutive patients （54 males, 79 females, age： （43.1 ± 14.9） years） suspected of CTEPH were prospectively en- rolled in the study. All patients underwent V/Q scintigraphy, CTPA and pulmonary angiography within 7 d of clinical presentation. Pulmonary angiography was considered as the gold standard. The diagnosis of CTEPH by V/Q scan was classified as high, intermediate and low probability, and that by CTPA was classi- fied as present, absent and indeterminate. Kappa test was used to analyze the concordance between the im- age modalities. Results Fifty-one patients （38.3%） had a final diagnosis of CTEPH. The other 82 pa- tients were respectively diagnosed with IPAH （n = 60）, pulmonary vasculitis （n = 19） and atrial septaldefect （n = 3）. The sensitivity, specificity and accuracy of V/Q scan were 96.1% （49/51）, 75.6% （62/ 82 ） and 83.5% （ 111/133 ）, respectively, when CTEPH with high probability was considered positive. The sensitivity, specificity and accuracy of V/Q scan were 100% （51/51）, 73.2% （60/82） and 83.5% （ 111/ 133 ） , respectively, when CTEPH with high or intermediate probability was considered positive. The sensi- tivity, specificity and accuracy of CTPA were 92.2% （47/51）, 92.7% （76/82） and 92.5% （ 123/133 ）, respectively. When CTEPH with high probability by V/Q scan was considered positive, the concordance be- tween V/Q scan and CTPA was 80.5% （107/133） （Kappa=0.612, P〈0.001）. Conclusions V/Q scan has a higher sensitivity for the diagnosis of CTEPH than CTPA. CTPA has a higher specificity than V/ Q scan to differentiate PAH caused by other diseases, especially pulmonary vasculitis, from CTEPH. Com- bining V/Q scan and CTPA may improve the diagnostic accuracy of CTEPH.

关 键 词：肺栓塞 高血压 肺性 放射性核素显像 锝 体层摄影术 X线计算机 DTPA 

分 类 号：R543.2[医药卫生—心血管疾病]