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

摘要

Objective To 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 compa-ring with pulmonary ventilation/ perfusion (V/ Q) SPECT imaging. Methods A total of 203 patients sus-pected 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 be-tween the two methods. Kappa analysis was used to analyze the agreement of them. Results The coinci-dence 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). Conclusion In 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.%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.