CAJ | 학술논문

目的：探讨肺通气/灌注SPECT-CT融合显像（V/P-SPECT-CT）在急性肺栓塞（APE）的诊断和排除诊断中的应用价值。方法回顾性收集2012年1月～2015年1月临床可疑APE患者116例，均接受肺V/P显像（平面显像和SPECT-低剂量融合CT显像），并在显像前/后2 d完成肺动脉CT造影（CTPA）检查，分析其在肺段、亚肺段APE病灶的诊断和排除诊断中的应用价值。结果75例确诊APE患者（受损肺段和亚肺段分别为240个和62个），肺V/P-SPECT-CT显像诊断APE的灵敏度、特异性、准确性、假阳性率、假阴性率分别为96.0%、92.7%、94.8%、7.3%和4.0%，特异性明显高于肺CTPA和肺P-SPECT-CT显像，假阳性率低于肺P-SPECT-CT显像，肺V/P-SPECT-CT显像可诊断出94.7%的APE病灶（肺段、亚肺段分别为235个和51个），明显高于CTPA（68.2%，194和12个）。肺V/P-SPECT-CT显像排除诊断中确诊慢性肺部疾病26例（COPD 10例，肺占位3例，叶间裂、胸腔积液7例，肺炎、肺不张等6例）。结论肺V/P-SPECT-CT显像结合功能和解剖学影像信息，诊断APE特异性高、假阳性率低，且在排除诊断中对非APE给予疾病诊断，具有较好的应有优势。
목적：탐토폐통기/관주SPECT-CT융합현상（V/P-SPECT-CT）재급성폐전새（APE）적진단화배제진단중적응용개치。방법회고성수집2012년1월～2015년1월림상가의APE환자116례，균접수폐V/P현상（평면현상화SPECT-저제량융합CT현상），병재현상전/후2 d완성폐동맥CT조영（CTPA）검사，분석기재폐단、아폐단APE병조적진단화배제진단중적응용개치。결과75례학진APE환자（수손폐단화아폐단분별위240개화62개），폐V/P-SPECT-CT현상진단APE적령민도、특이성、준학성、가양성솔、가음성솔분별위96.0%、92.7%、94.8%、7.3%화4.0%，특이성명현고우폐CTPA화폐P-SPECT-CT현상，가양성솔저우폐P-SPECT-CT현상，폐V/P-SPECT-CT현상가진단출94.7%적APE병조（폐단、아폐단분별위235개화51개），명현고우CTPA（68.2%，194화12개）。폐V/P-SPECT-CT현상배제진단중학진만성폐부질병26례（COPD 10례，폐점위3례，협간렬、흉강적액7례，폐염、폐불장등6례）。결론폐V/P-SPECT-CT현상결합공능화해부학영상신식，진단APE특이성고、가양성솔저，차재배제진단중대비APE급여질병진단，구유교호적응유우세。
Objective To investigate the effectiveness of pulmonary ventilation/perfusion SPECT (Single-Photon Emission Computed Tomography) combined with low-dose CT (V/P-SPECT-CT) imaging in diagnosis of APE (Acute Pulmonary Embolism). Methods Medical imaging data of 116 suspected APE patients who were scanned by pulmonary V/P-SPECT-CT from January 2012 to January 2015 were retrospectively collected. CTPA (Computed Tomography Pulmonary Angiography) was performed in all the patients two days before/after V/P-SPECT-CT scanning so as to analyze the effectiveness of application of V/P-SPECT-CT in diagnosis and exclusive diagnosis of pulmonary segment and sub-segment APE lesions. Results Among 75 identiifed APE cases (240 affected pulmonary segments and 62 affected pulmonary sub-segments), the diagnostic sensitivity, speciifcity, accuracy, false positive rate and false negative rate of V/P-SPECT-CT for APE were 96%, 92.7%, 94.8%, 7.3%and 4%, respectively. Its diagnostic speciifcity was higher than that of CTPA and pulmonary P-SPECT-CT. Its false positive rate was lower than that of pulmonary P-SPECT-CT. Altogether 94.7%of APE lesions (235 pulmonary segments and 51 pulmonary sub-segments) were displayed on V/P-SPECT-CT imaging, which was obviously higher than that of CTPA (68.2%, 194 segments and 12 subsegment). In non-APE cases, 26 patients with chronic pulmonary diseases [including 10 with COPD (Chronic Obstructive Pulmonary Diseases);3 with pulmonary space occupying;7 with pleural or encapsulated effusion;6 with pneumonia or pulmonary closure] were revealed on pulmonary V/P-SPECT-CT imaging. Conclusion In combination with functional and anatomical imaging information, pulmonary V/P-SPECT-CT fusion imaging proved its advantages of higher diagnostic speciifcity and lower false negative rate in diagnosis of APE and also could provide diagnosis for non-APE patients, which had great advantages in the application.