肺通气／灌注显像在慢性血栓栓塞性肺动脉高压诊断中的临床价值  

Lung ventilation/perfusion imaging in the diagnosis of chronic thromboembolic lmlmonarv hyoertension-in comparison with CT pulmonary angiography

作　　者：张春[1] 王铁[1] 马展鸿[2] 丁毅[2] 曲士颖[1] 黄京伟[1] 

机构地区：[1]首都医科大学附属北京朝阳医院核医学科,100020 [2]首都医科大学附属北京朝阳医院放射科,100020

出　　处：《中华核医学与分子影像杂志》2013年第4期254-257,共4页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的探讨肺通气／灌注（V／Q）显像在慢性血栓栓塞性肺动脉高压（CTEPH）诊断中的临床价值。方法回顾性分析临床怀疑CTEPH的76例患者（男46例，女30例，年龄27—84岁）的肺V／Q断层显像结果，与CT肺动脉造影（CTPA）检查结果进行比较。分别计算核素显像与CTPA诊断CTEPH的灵敏度、特异性、准确性、阳性预测值和阴性预测值，并应用SPSS11．5软件行疋。检验，对2种方法诊断效能进行比较。同时对CTEPH患者V／Q显像受累肺段的分布进行分析。结果临床最终确诊CTEPH47例（肺动脉造影或病史结合影像学检查结果确诊），非CTEPH29例。V／Q显像对CTEPH的诊断灵敏度、特异性、准确性、阳性预测值和阴性预测值分别为97．9％（46／47）、86．2％（25／29）、93．4％（71／76）、92．0％（46／50）和96．2％（25／26），CTPA的检查对应结果分别为78．7％（37／47）、93．1％（27／29）、84．2％（64／76）、94．9％（37／39）和73．0％（27／37），V／Q显像的灵敏度（∥=5．818，P=0．012）和阴性预测值（X^2=5．693，P=0．017）均高于CTPA。V／Q显像可以对CTEPH和特发性PAH及遗传性PAH进行鉴别诊断：CTEPH患者灌注显像呈肺叶、肺段分布的稀疏缺损区，而通气显像基本正常，特发性及遗传性PAH灌注显像则表现为不呈肺段分布的多发、散在的“斑片状”稀疏缺损区或血流灌注基本正常。在47例CTEPH患者的940个肺段中，肺灌注断层显像共检出585个（62．2％）受累肺段，平均每例患者有12．4个肺段受累，右肺受累比例明显高于左肺[36．2％（340／940）与26．1％（245／940）X^2=40．85，P〈0．01]。结论V／Q显像在CTEPH的诊断和鉴别诊断中具有较高的临床应用价值。V／Q显像正常可排除CTEPH的诊断；而在临床高度怀疑CTEPH、CTPA与肺动脉造影检查均为阴性时，V／Q显像对CTEPH的诊断具有重要意义。Objective To evaluate the lung V/Q imaging in the diagnosis of chronic thromboem- bolic pulmonary hypertension （CTEPH）. Methods Seventy-six patients （46 males, 30 females, age 27- 84 y） with clinically suspected CTEPH who had undergone lung V/Q imaging, CT pulmonary angiography （CTPA） , pulmonary angiography （PA） and right heart cardiac catheterization were studied. The sensitivi- ty, specificity, accuracy, positive predictive value and negative predictive value of lung V/Q imaging in de- tecting CTEPH were calculated and compared with those of CTPA. TheX2 test was used for statistical analy- sis with SPSS 11.5. The distribution of involvement of segments in 47 patients with CTEPH was analyzed. Results Forty-seven patients had a final diagnosis of CTEPH and 29 had non-CTEPH etiology. The sensi- tivity, specificity, accuracy, positive predictive value and negative predictive value of lung V/Q imaging were 97.9% （46/47）, 86.2% （25/29）, 93.4% （71/76）, 92.0% （46/50） and 96.2% （25/26）, while those of CTPA were 78.7% （37/47）, 93.1% （27/29）, 84.2% （64/76）, 94.9% （37/39） and 73.0% （27/37）, respectively. The sensitivity （X^2 =5.818, P=0.012） and negative predictive value （X^2= 5.693,P= 0.017） for lung V/Q imaging were significantly higher than those of CTPA. V/Q imaging could identify patients with CTEPH from those with idiopathic PAH and familial PAH based on the almost normal ventila- tion imaging. The lung perfusion SPECT imaging detected 585 （62.2%） of involved segments among 940 segments in 47 patients with CTEPH, with an average of 12.4 involved segments in each patient. The num- ber of involved segments in the right lung was significantly higher than that in the left lung （ 36.2% （ 340/ 940） vs 26.1% （245/940） ; X^2 =40.85, P〈0.01）. Conclusions Lung V/Q imaging plays an important role in diagnosis of CTEPH and in identification of CTEPH from other types of PAH. A normal V/Q imaging can effectively exclude CTEPH. In addition, V/Q imagi

关 键 词：高血压 肺性 血栓栓塞 放射性核素显像 MAA 

分 类 号：R544.16[医药卫生—心血管疾病]