CAJ | 학술논문

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x2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PE 80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％ CI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.
목적 탐토일일법폐통기/관주(V/Q)단층현상여라선CT폐동맥조영(CTPA)대폐동맥전새(PE)적진단효능.방법 림상학진혹의진폐동맥전새환자111례행일일법폐V/Q평면화단층현상,병우완성폐V/Q현상전후3d내동시행상규CTPA,전부환자수진지소6개월.삼조2009년구주핵의학회PE진단지남중적단층현상진단표준화수정후적PIOPEDⅡ표준,분석여평고진단결과,분별장단층화평면진단결과분위3충:PE、비PE화불학정진단.CTPA도상근거폐전새진단적직접정상화간접정상평개도상,장진단결과역분위PE、비PE화불학정진단.최종진단이종합분석각영상학결과、실험실검사、림상가능성평고이급6개월적수방결과래판정위학진PE혹배제PE.통계학분석운용x2검험화ROC곡선분석득도삼충영상진단방법적진단효능지표화곡선하면적(AUC),비교진단효능,동시비교기불학정진단솔차이.결과 111례중학진PE 80례,배제31례,V/Q단층현상진단적민감도위85.9％,특이도위93.5％,준학솔위88.1％；V/Q평면현상진단적민감도위75.7％,특이도위92.9％,준학솔위81.4％；CTPA진단적민감도위85.5％,특이도위90.0％,준학솔위86.8％.ROC곡선분석결과표명V/Q단층현상、평면현상화CTPA적곡선하면적급95％ CI분별위0.898(0.831 ～0.966),0.838(0.759 ～0.917)화0.877(0.801 ～0.954).결론 운용ROC분석현시폐V/Q단층현상、평면현상화CTPA대PE진단개치재중도이상,종합분석득출V/Q단층현상우우평면V/Q현상화CTPA,폐V/Q단층현상가명현강저진단중적불학정솔；능성위림상진단PE적유효검사수단.
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 multicenter 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 respiratory physicians,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 (P ＜ 0.05) as compared with the area under the reference line.Conclusion The results indicate that SPECT V/Q imaging is superior to V/Q planar scan and CTPA in the diagnosis of PE.