肺灌注断层显像和平面显像对肺栓塞诊断的价值研究.docx

肺灌注断层显像和平面显像对肺栓塞诊断的价值研究[摘要]目的:评价肺灌注断层显像对肺栓塞(PE)的诊断价值。方法:对76例确诊为PE的患者进行肺灌注断层和平面显像次日行肺通气显像显像结果和CT肺动脉造影(CTPA)进行对比分析。结果:在76例PE患者中肺灌注断层显像阳性72例检出率为94.7%;肺灌注平面显像阳性64例检出率为84.2%两种方法PE检出率差异有统计学意义(P[关键词]肺栓塞;核素肺灌注显像;CTPA[中图分类号]R445.5[文献标识码]B[文章编号]1673-7210(2010)02(a)-067-02TheroleoflungperfusiontomographyinthediagnosisofpulmonaryembolismincomparisonwithplanarperfusionimagingLIUYan1MAOYimin2HUBin1*(1.DepartmentofNuclearMedicinetheFirstAffiliatedHospitalofHe'nanScienceandTechnologyUniversityLuoyang471003China;2.DepartmentofRespiratoryMedicinetheFirstAffiliatedHospitalofHe'nanScienceandTechnologyUniversityLuoyang471003China)[Abstract]Objective:Toevaluatetheclinicalvalueoflungperfusiontomographyinthediagnosisofpulmonaryembolism(PE).Methods:Lungperfusiontomographyandplanarimagingweredonein76patientswithplanarperfusionimagingofPE.TheresultswerecomparedwiththoseofspiralCTpulmonaryarteriography(CTPA).Results:Amongallthe76patientswithlungperfusiontomographyandplanarimagingthedetectionratesofPEwere94.7%(72cases)and84.2%(64cases)respectively.Therewasasignificantdifferencebetweenthetwomethods(P[Keywords]Pulmonaryembolism;Lungperfusionimaging;CTPA肺栓塞是国际性的重要医疗课题[1]我国肺栓塞(pulmonaryembolismPE)的发病率逐年上升病死率居第3位仅次于恶性肿瘤和心肌梗死[2]。目前认为肺通气/灌注(lungventilation/perfusionscintigraphyV/Q)多体位平面显像是诊断PE的首选筛查方法[3]但其检出率仅为50%～80%[4]。本研究针对已确诊为PE的76例患者进行肺灌注平面显像随后行断层显像评判肺灌注断层显像对PE的诊断价值。1资料与方法1.1一般资料本组共观察76例患者其中男性49例女性27例;平均年龄(48.3±17.8)岁。全部患者均通过CT肺动脉造影(CTPA)确诊为PE。入选标准为:①年龄≤70岁;②发病时间1.2显像方法1.2.1肺灌注平面显像患者取平卧位静脉注射99Tcm-聚合清蛋白(MMA)185～370MBq注射中嘱患者深呼吸。患者双手抱头使探头尽量贴近胸部。显像仪器为GESPECT(SPX-6)高分辨准直器。采集6个体位:前、后、右、左、左后斜和右后斜位。每个体位计数5×105矩阵为256×256放大倍数为1.5倍。1.2.2肺灌注断层显像肺灌注平面显像完成后进行断层扫描。旋转360°每6°一帧每帧采集30s共采集60帧矩阵为64×64放大倍数为1.5倍。采集中嘱患者平稳呼吸。原始数据经处理得到3个切面的断层图像。1.2.3肺通气显像采用DTPA气溶胶法将1.48GBq(