Paul J F, Fiessinger J N, Hernigou A, Sapoval M, Emmerich J, Gaux J C
Service de radiologie vasculaire, Hôpital Broussais, 96, rue Didot, 75674 Paris Cedex 14.
J Radiol. 2000 Aug;81(8):882-4.
To assess the value of ventilation-perfusion scintigraphy after an initial helical CT with absence of pulmonary embolism (PE).
and methods. Twenty eight consecutive patients with clinical suspicion of pulmonary embolism underwent helical CT scan to look for an intra-luminal clot. When the CT-scan was positive for PE, diagnosis was retained. If the result was negative, a ventilation-perfusion scintigraphy was performed. If the result was also negative, diagnosis of PE was excluded. In case of discrepancy, a pulmonary angiography was performed and used as gold-standard.
Twenty-one patients showed PE at CT-angio and 7 did not. Two of these 7 had normal or low probability scintigraphy, excluding diagnosis of PE. One had intermediate V/P scan and 4 had high probability V/P scan. For these 5 discrepancies, none of them had PE on angiography.
In this population, scintigraphy was not appropriate after a negative CT-angio for PE. In case of persistent doubt after a normal initial helical CT, pulmonary angiography is required
评估在初次螺旋CT未发现肺栓塞（PE）后进行通气灌注闪烁扫描的价值。
连续28例临床怀疑肺栓塞的患者接受螺旋CT扫描以寻找腔内血栓。当CT扫描显示PE阳性时，确诊。如果结果为阴性，则进行通气灌注闪烁扫描。如果结果也为阴性，则排除PE诊断。如有差异，则进行肺动脉造影并将其用作金标准。
21例患者在CT血管造影中显示有PE，7例未显示。这7例中的2例闪烁扫描结果正常或可能性低，排除了PE诊断。1例V/P扫描为中等可能性，4例V/P扫描为高可能性。对于这5例差异，血管造影均未显示有PE。
在该人群中，CT血管造影对PE呈阴性后进行闪烁扫描不合适。如果初次螺旋CT正常后仍存在疑问，则需要进行肺动脉造影。
