肺通气／灌注断层显像与CT肺动脉造影诊断肺动脉栓塞效能的对比研究  

A comparison of ventilation/perfusion single photon emission CT and CT pulmonary angiography fordiagnosis of pulmonary embolism

作　　者：孟晶晶[1] 张丽军[1] 王蒨[1] 方纬[2] 戴皓洁[3] 颜珏[4] 王铁[5] 姚稚明[6] 何嘉[2] 李眉[3] 米宏志[1] 焦建[1] 郑玉民[4] 

机构地区：[1]首都医科大学附属北京安贞医院,100029 [2]中国医学科学院阜外心血管病医院 [3]首都医科大学附属北京同仁医院 [4]卫生部中日友好医院 [5]首都医科大学附属北京朝阳医院 [6]卫生部北京医院

出　　处：《中华结核和呼吸杂志》2013年第3期177-181,共5页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：北京市科技计划项目临床特色应用（D101100050010034）

摘　　要：目的探讨一日法肺通气／灌注（V／Q）断层显像与螺旋cT肺动脉造影（CTPA）对肺动脉栓塞（PE）的诊断效能。方法临床确诊或疑诊肺动脉栓塞患者111例行一日法肺V／Q平面和断层显像，并于完成肺V／Q显像前后3d内同时行常规CTPA，全部患者随诊至少6个月。参照2009年欧洲核医学会PE诊断指南中的断层显像诊断标准和修订后的PIOPEDⅡ标准，分析与评估诊断结果，分别将断层和平面诊断结果分为3种：PE、非PE和不确定诊断。CTPA图像根据肺栓塞诊断的直接征象和间接征象评价图像，将诊断结果亦分为PE、非PE和不确定诊断。最终诊断以综合分析各影像学结果、实验室检查、临床可能性评估以及6个月的随访结果来判定为确诊PE或排除PE。统计学分析运用X^2检验和ROC曲线分析得到三种影像诊断方法的诊断效能指标和曲线下面积（AUC），比较诊断效能，同时比较其不确定诊断率差异。结果111例中确诊PE80例，排除31例，V／Q断层显像诊断的敏感度为85．9％，特异度为93．5％，准确率为88．1％；V／Q平面显像诊断的敏感度为75．7％，特异度为92．9％，准确率为81．4％；CTPA诊断的敏感度为85．5％，特异度为90．0％，准确率为86．8％。ROC曲线分析结果表明V／Q断层显像、平面显像和CTPA的曲线下面积及95％C1分别为0．898（0．831-0．966），0．838（0．759-0．917）和0．877（0．801-0．954）。结论运用ROC分析显示肺V／Q断层显像、平面显像和CTPA对PE诊断价值在中度以上，综合分析得出V／Q断层显像优于平面V／Q显像和CTPA，肺V／Q断层显像可明显降低诊断中的不确定率；能成为临床诊断PE的有效检查手段。Objective To assess the diagnostic accuracy of ventilation/perfusion （V/Q） single photon emission CT （SPECT） as compared to computed tomographic pulmonary angiography （CTPA） for pulmonary embolism（PE）. Methods In this prospective muhicenter study, 111 patients in whom acute or sub-acute PE was clinically confirmed or suspected were enrolled. The patients underwent one-day method V/Q lung scan （including SPECT and planar imaging） within 3 days before and after completion of CTPA. The European Association of Nuclear Medicine （EANM） guidelines for ventilation/perfusion scintigraphy （2009） reference was used as the evaluation criteria of V/Q SPECT imaging. The refined modified prospective investigation of pulmonary embolism diagnosis （RM-PIOPED） criteria was used for evaluation of planar imaging. According to the direct and indirect signs of PE, the imaging of CTPA was evaluated. All patients were followed for at least 6 months. A diagnosis was finally made by consensus of respiratoryphysicians, radiologists and nuclear medicine physicians based on the clinical data, laboratory tests, imaging features and follow-up results. The difference among diagnostic methods was evaluated for significance using chi-square test. The receiver operator characteristic （ROC） curve was drawn according to the results of the 3 diagnostic tests. The area under ROC curve （AUC） was calculated and compared. P 〈 0.05 was considered statistically significant. Results Among the 111 patients, PE was confirmed in 80, and excluded in 31. The diagnostic sensitivity/specificity/accuracy of V/Q SPECT, planar imaging, and CTPA were 85.9%/ 93.5%/88.1%, 75.7%/92. 9%/81.4%, and 85.5%/90. 0%/86. 8%, respectively. By ROC curve analysis, the AUC values of V/Q SPECT, planar imaging and CTPA were 0. 898, 0. 838, and 0. 877, respectively; with 95% confidence intervals [ CI] 0. 831 to 0. 966, 0. 759 to 0. 917, and 0. 801 to 0. 954, respectively. The area of the fitted smooth ROC curve was statistically significant （

关 键 词：肺栓塞 体层摄影术 X线计算机 放射性核素显像 

分 类 号：R563.5[医药卫生—呼吸系统]