SPECT V/Q 断层显像半定量分析联合测定血浆 D-二聚体诊断肺栓塞的价值

摘要

To evaluate the early and accurate diagnostic value of SPECT V/Q imaging combined with D-dimer assay,especially in non massive pulmonary embolism group.156 patients with computed tomographic pulmonary angiography (CTPA),Geneva score, response of anticoagulation treatments,who was selected from 321 patients with clini-cally suspected pulmonary embolism (PE)referred to the Nuclear Medicine Department of Beijing Anzhen Hospital from January to July 2014,were enrolled in the study.The patients were divided into PE group (n=101)and non PE group (n=55).We compared the diagnostic performance of SPECT V/Q,D-dimer and SPECT V/Q combined with D-dimer measurement.The SPECT V/Q images were reconstructed by Oasis of Philips and interpreted by the attending nuclear physician using a diagnostic cut-off of one segmental or two subsegmental mismatches.D-dimer had good sensitivity of 70.3% and bad specificity of 61.8% in the 156 patients.SPECT V/Q had good performance both sensitivity (85.1%)and specificity (90.9%).But when SPECT V/Q combined with D-dimer,there were best diagnostic sensitivity (91.1%)and specificity (98.2%)in PE detection,especially in embolization extent less than 15%.SPECT V/Q combined with D-dimer measurement are effective and safe diagnostic management.%研究 V/Q 断层显像半定量分析联合测定血浆 D-二聚体早期、准确诊断肺栓塞的价值,尤其在小面积肺栓塞诊断中的应用优势。疑诊肺栓塞来核医学科行 V/Q 断层显像患者共156例,以 CT 肺血管造影(computed tomographic pulmonary angiography,CTPA)检查及临床诊断为分组标准,肺栓塞组患者101例,非肺栓塞组患者55例。比较 SPECT V/Q 断层显像、血浆 D-二聚体测定以及 SPECT V/Q 断层显像联合血浆 D-二聚体测定三种方法对肺栓塞的诊断效能。应用 Philips 公司 Oasis 图像后处理软件对栓塞面积进行半定量分析,进一步评估对于肺栓塞面积占双肺容积≤15%的小面积肺栓塞的诊断价值。结果显示,血浆 D-二聚体测定对于肺栓塞的诊断有较高的灵敏度(70.3%),但是特异性(61.8%)差；SPECT V/Q 断层显像半定量分析对于肺栓塞的诊断具有较高的灵敏度和特异性,分别为85.1%、90.9%；而二者联合应用,诊断肺栓塞效能最高,灵敏度和特异性分别为91.1%、98.2%。其中 SPECT V/Q 断层显像半定量分析对于肺栓塞面积小于15%的小面积肺栓塞诊断有优势。放射性核素 SPECT V/Q 断层显像联合测定血浆 D-二聚体能显著提高肺栓塞的诊断效能,是临床实用、安全有效的肺栓塞疑诊患者诊断策略。