不同原因导致的慢性肺血管狭窄SPECT/CT肺血流灌注显像特征分析  

Characteristics of SPECT/CT-derived pulmonary perfusion imaging in chronic pulmonary vascular stenosis with different etiologies

作　　者：苏新 王海军[1] 李博 周明方 段一超 蒋凯煜 王阿倩 王茸 曹云山[2] Su Xin;Wang Haijun;Li Bo;Zhou Mingfang;Duan Yichao;Jiang Kaiyu;Wang Aqian;Wang Rong;Cao Yunshan(Department of Nuclear Medicine,Gansu Provincial Hospital,Lanzhou 730000,China;Department of Cardiology,Pulmonary Vascular Disease Center,Gansu Provincial Hospital,Lanzhou 730000,China;The First Clinical Medical College,Gansu University of Traditional Chinese Medicine,Lanzhou 730000,China;Department of Cardiology,Xianyang Central Hospital,Xianyang 712000,China)

机构地区：[1]甘肃省人民医院核医学科,兰州730000 [2]甘肃省人民医院心内科肺血管病中心,兰州730000 [3]甘肃中医药大学第一临床医学院,兰州730000 [4]咸阳市中心医院心内科,咸阳712000

出　　处：《中华心血管病杂志》2023年第9期970-976,共7页Chinese Journal of Cardiology

摘　　要：目的探讨不同原因导致的慢性肺血管狭窄单光子发射计算机断层成像(SPECT/CT)肺血流灌注显像特征。方法本研究为回顾性研究。纳入2019年1月至2020年1月于甘肃省人民医院心内科明确诊断为慢性肺血管狭窄并行SPECT/CT肺血流灌注检查的患者50例,排除病程小于3个月、非慢性病变所致的肺血管狭窄、图像质量差的患者13例后,根据肺血管狭窄的病因将患者分为纤维纵隔炎组(FM组)、大动脉炎累及肺动脉组(PTA组)和慢性血栓栓塞性肺高血压/慢性血栓栓塞性疾病组(CTEPH/CTED组);依据肺血流灌注Begic评分原则,对3组患者肺血流灌注进行评定,比较3组患者Begic总体评分、各肺叶评分;同时,对3组患者SPECT/CT的肺部CT征象(如肺门淋巴结增大、肺不张、支气管狭窄)进行分析。结果共纳入37例慢性肺血管狭窄患者,其中FM组18例,PTA组5例,CTEPH/CTED组14例。3组患者总体Begic评分差异无统计学意义(F=0.657,P>0.05);3组患者左上叶Begic评分差异有统计学意义(H=4.081,P<0.05),其中FM组左上叶Begic评分较PTA组高[(3.44±2.50)分比(1.60±0.55)分,P<0.05]。FM组CT征象肺门增大(FM组比PTA组:16/18比1/5,P=0.008;FM组比CTEPH/CTED组:16/18比3/14,P=0.0002)、肺门淋巴结增大(FM组比PTA组:14/18比1/5,P=0.033;FM组比CTEPH/CTED组:14/18比2/14,P=0.001)、纵隔软组织钙化(FM组比PTA组:11/18比0/5,P=0.037;FM组比CTEPH/CTED组:11/18比1/14,P=0.003)比例较其他两组高,FM组CT征象支气管狭窄(9/18比0/14,P=0.002)、肺不张(9/18比1/14,P=0.002)比例较CTEPH/CTED组高;当肺血流灌注异常时,CT征象肺门增大、肺门淋巴结增大、纵隔软组织钙化、支气管狭窄、肺不张诊断FM的准确性分别为81.1%、83.8%、78.4%、75.7%、73.0%。结论3组患者SPECT/CT肺血流灌注Begic评分差异无统计学意义;但胸部CT征象对FM的识别有一定帮助。ObjectiveTo explore the characteristics of pulmonary blood flow perfusion imaging of single photo emission computer tomography/computer tomography(SPECT/CT)in chronic pulmonary vascular Stenosis(CPVS)caused by different etiological factors.MethodsThis is a retropective study.Present study screened 50 consecutive cases diagnosed with chronic pulmonary vascular stenosis from January 2019 to January 2020 in the department of cardiology of Gansu Provincial Hospital and underwent SPECT/CT pulmonary blood flow perfusion examination.Thirteen patients were excluded because of pulmonary vascular lesions with a disease course of less than 3 months and poor image quality.According to the etiology,patients were divided into fibrosing mediastinitis(FM)group,Takyasu′s arteritis(PTA)group,and chronic thromboembolic pulmonary hypertension/chronic thromboembolic pulmonary disease(CTEPH/CTED)group.The severity of pulmonary blood flow perfusion was evaluated in accordance with the Begic scoring principle in the three groups.The overall Begic score,lung lobe scores among three groups were compared.CT signs of lung SPECT/CT,such as enlargement of hilar lymph node,atelectasis,bronchial stenosis,were also analyzed in three groups.ResultsA total of 37 patients with chronic pulmonary vascular stenosis were finally enrolled(18 in the FM group,5 in the PTA group,and 14 in the CTEPH/CTED group).The total Begic score of pulmonary perfusions was similar among the three groups(F=0.657,P>0.05).There was a statistically significant difference in the left upper lobe Begic score among the three groups(H=4.081,P<0.05).The left upper lobe Begic score was higher in the FM group than in the PTA group(3.44±2.50 vs.1.60±0.55,P<0.05).As compared to other two groups,patients in FM group were featured with CT signs of higher percent of hilar enlargement(FM group vs.PTA group:16/18 vs.1/5,P=0.008;FM group vs.CTEPH/CTED group:16/18 vs.3/14,P=0.0002),enlargement of the pulmonary hilum lymph nodes(FM group vs.PTA group:14/18 vs.1/5,P=0.033;FM group vs.CTEP

关 键 词：TAKAYASU动脉炎 纤维纵隔炎 慢性血栓栓塞性肺高血压 慢性血栓栓塞性疾病 单光子发射计算机断层显像 

分 类 号：R563[医药卫生—呼吸系统]