核素肺灌注显像结合PISA-PED评价标准与CT肺动脉造影诊断肺栓塞的对比研究

摘要

目的 比较核素肺灌注显像结合PE诊断前瞻性研究(PISA-PED)评价标准与CT肺动脉造影(CTPA)诊断PE的效能.方法 前瞻性纳入104例连续性疑似PE患者,其中男54例,女50例,年龄(50±15)岁.排除标准为:孕妇、肾功能衰竭患者、已接受溶栓或抗凝治疗患者或有造影剂过敏史患者.所有患者均行核素肺灌注显像、CTPA及胸部X线检查.采用PISA-PED评价标准判读核素肺灌注显像图.最终诊断采用临床综合诊断.应用Kappa检验分析肺灌注显像与CTPA结果的一致性,应用非参数检验或x2检验分析2种诊断方法结果间的差异性.结果 104例患者中55例被最终诊断为PE.在排除3例(2.9％)CTPA“不能诊断”者后,肺灌注显像的灵敏度、特异性、阳性预测值及阴性预测值分别为92.6％ (50/54)、83.0％( 39/47)、86.2％( 50/58)和90.7％ (39/43);CTPA的灵敏度、特异性、阳性预测值及阴性预测值分别为96.3％ (52/54)、93.6％( 44/47)、94.5％( 52/55)和95.7％ (44/46).2种显像方法的诊断符合率为89.1％(90/101),Kappa =0.78,P＜0.05.在肺段水平,共分析了1664个肺段,肺灌注显像与CTPA的诊断符合率为79.7％ (1327/1664),Kappa=0.58,P＜0.05.结论 核素肺灌注显像结合PISA-PED评价标准与CTPA诊断PE的效能相近,两者均有较好的诊断效能.2种显像方法在肺段水平为中度符合.%Objective To compare the diagnostic efficiency of lung perfusion scans in PE interpreted by prospective investigative study of PE diagnosis (PISA-PED) criteria with contrast-enhanced multislice spiral CT pulmonary angiography ( CTPA ).Methods One hundred and four consecutive patients with suspected PE were enrolled. All patients underwent lung perfusion scans,CTPA and chest radiography.Lung perfusion scans were interpreted by PISA-PED criteria.Final diagnosis was confirmed using a composite reference test.Kappa test was used to analyze the degree of agreement between the multimodality images.The differences between the multimodality images were tested for significance using nonparametric test or x2-test.Results PE was finally diagnosed in 55 of the 104 patients.After excluding three patients ( 2.9％ )with non-diagnostic CTPA from analysis,the sensitivity,specificity,positive predictive value and negative predictive value were 92.6％ ( 50/54),83.0％ ( 39/47 ),86.2％ ( 50/58 ),90.7％ ( 39/43 ) respectively for lung perfusion scans,and 96.3％ ( 52/54 ),93.6％ ( 44/47 ),94.5％ ( 52/55 ),95.7％ ( 44/46 ) respectively for CTPA.The agreement rate between the two modalities was 89.1％ (90/101 ; Kappa =0.78,P ＜0.05).In the segment-based analysis,a total of 1664 segments were evaluated.The agreement rate between lung perfusion scans and CTPA was 79.7％ ( 1327/1664; Kappa =0.58,P ＜0.05 ).Conclusions Lung perfusion scans interpreted by PISA-PED criteria can provide diagnostic accuracy comparable to CTPA,and the two modalities both show high efficacy in diagnosing PE.The agreement between lung perfusion scans and CTPA was intermediate on a segment-by-segment basis.