肺灌注SPECT显像/同机低剂量CT融合显像诊断急性肺栓塞的价值  

Value of pulmonary perfusion tomography/low dose CT fusion imaging in the diagnosis of acute pulmonary embolism

作　　者：陈聪霞[1] 姚稚明[1] 郭悦[1] 李旭[1] 许小毛[2] 刘秀芹[1] 许斌[1] Chert Congxia;Yao Zhiming;Guo Yue;Li Xu;Xu Xiaomao;Liu Xiuqin;Xu Bin(Department of Nuclear Medicine,Beijing Hospital,National Center of Gerontology,Beijing 100730,China;Department of Respiratory and Critical Care Medicine,Beijing Hospital,National Center of Gerontology,Beijing 100730,China)

机构地区：[1]北京医院核医学科、国家老年医学中心,100730 [2]北京医院呼吸与危重症医学科,100730

出　　处：《中华核医学与分子影像杂志》2018年第10期649-653,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：国家精准医学研究项目（2016YFC0905602）

摘　　要：目的探讨肺灌注SPECT显像/同机低剂量CT融合显像（Q SPECT/CT）诊断急性肺栓塞（PE）的价值，并与肺通气/灌注（V/Q） SPECT比较。方法回顾性分析2013年1月至2015年12月间203例（男88例，女115例，年龄19～94岁）临床疑诊急性PE患者的V/Q SPECT、同机低剂量胸部CT及临床资料，以临床最终出院诊断作为＂金标准＂，比较Q SPECT/CT与V/Q SPECT的诊断一致性及诊断效能。采用χ2检验比较二者的差异，Kappa分析比较二者的一致性。结果Q SPECT/CT和V/Q SPECT之间的诊断符合率为94.09%（191/203；Kappa＝0.882，P〈0.001），两者高度相符。2种影像模式诊断不符者12例，其中9例临床最终诊断为慢性阻塞性肺部疾病（COPD）。Q SPECT/CT诊断PE的灵敏度、特异性、阳性预测值、阴性预测值及准确性分别为95.12%（78/82）、80.99%（98/121）、77.23%（78/101）、96.08%（98/102）、86.70%（176/203）；V/Q SPECT诊断PE的灵敏度、特异性、阳性预测值、阴性预测值及准确性分别为95.12%（78/82）、90.91%（110/121）、87.64%（78/89）、96.49%（110/114）、92.61%（188/203）。Q SPECT/CT与V/Q SPECT比较，诊断灵敏度相同，特异性有差异（χ2＝4.928，P＝0.026）、阳性预测值、阴性预测值及准确性虽有降低，但差异均无统计学意义（χ2值：3.491、0.000、3.824，均P〉0.05）。结论Q SPECT/CT检查在大部分情况下可以替代V/Q SPECT诊断急性PE，但对于伴有COPD病史患者的诊断需谨慎选用。ObjectiveTo evaluate the diagnostic efficacy of the pulmonary perfusion tomography combined with low dose CT scan （Q SPECT/CT） in detecting acute pulmonary embolism （PE） by comparing with pulmonary ventilation/perfusion （V/Q） SPECT imaging.MethodsA total of 203 patients suspected with acute PE （88 males, 115 females, age range 19-94 years） from January 2013 to December 2015 were enrolled in this retrospective study. All patients underwent V/Q SPECT and low dose CT scan. Final clinical diagnosis was regarded as the gold standard. The diagnostic consistency and diagnostic efficacy of Q SPECT/CT were compared with those of V/Q SPECT. χ2 test was used to compare the differences between the two methods. Kappa analysis was used to analyze the agreement of them.ResultsThe coincidence rate of Q SPECT/CT and V/Q SPECT was 94.09%（191/203）, Kappa=0.882, P〈0.001. Among the 12 cases with inconsistent diagnosis, 9 were finally diagnosed as chronic obstructive pulmonary disease （COPD）. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of Q SPECT/CT in the diagnosis of PE were 95.12%（78/82）, 80.99%（98/121）, 77.23%（78/101）, 96.08%（98/102）, 86.70%（176/203）. The counterpart parameters of V/Q SPECT were 95.12%（78/82）, 90.91%（110/121）, 87.64%（78/89）, 96.49%（110/114）, 92.61%（188/203）. Compared with V/Q SPECT, Q SPECT/CT had the same sensitivity but lower specificity （χ2=4.928, P=0.026）. The positive predictive value, negative predictive value and accuracy of Q SPECT/CT were lower than those of V/Q SPECT, but there was no significant difference （χ2 values： 3.491, 0.000, 3.824, all P〉0.05）.ConclusionIn the majority of patients with suspected acute PE, V/Q SPECT scan can be replaced by Q SPECT/CT, but it must be careful to select Q SPECT/CT for patients with COPD history.

关 键 词：肺栓塞 体层摄影术 发射型计算机 单光子 体层摄影术 X线计算机 锝 99m锝聚 集白蛋白 

分 类 号：R563.5[医药卫生—呼吸系统] R816.41[医药卫生—内科学]