Magnant J, Vecellio L, de Monte M, Grimbert D, Valat C, Boissinot E, Guilloteau D, Lemarié E, Diot P
INSERM U 618, IFR 135, CHU Bretonneau, Tours, France.
J Aerosol Med. 2006 Summer;19(2):148-59. doi: 10.1089/jam.2006.19.148.
A study was carried out to investigate the predictive value of 81-metastable-krypton (81mKr) distribution, high-size 99-metastable-technetium (99mTc) aerosol deposition and low-size 99mTc aerosol (Technegas) deposition on the pulmonary ventilation evaluated by 133-xenon (133Xe) lung scintigraphy, and to assess the correlation between the 81mKr distribution, the 99mTc aerosols deposition, and the respiratory parameters of patients with chronic obstructive pulmonary disease (COPD). Twenty COPD patients were included. The 81mKr, 133Xe, and 99mTc aerosol lung scintigraphies were successively carried out. The 81mKr distribution and 99mTc deposition were compared to the 133Xe distribution at equilibrium and to the 133Xe clearance. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 81mKr and Technegas lung scintigraphies to detect alterations in ventilation revealed by 133Xe were defined. The 81mKr distribution and 99mTc deposition according to respiratory parameters were described using a principal component analysis. Compared to 133Xe distribution, a significantly higher distribution of 81mKr in the upper parts of the lungs in the more severe patients (p = 0.05), a significantly higher deposition of Technegas in the lower parts of the lungs (p = 0.0008), and a significantly higher deposition in the central parts of the high-size 99mTc aerosol were observed (p = 0.0001). The PPV and the NPV were, respectively, 0.54 and 0.58 for 81mKr and 0.54 and 0.55 for Technegas. There was a significant negative correlation between 81mKr distribution and 133Xe clearance (p = 0.0001) between Technegas deposition and 133Xe clearance (p = 0.0007), and between 99mTc diethylene-triamino-penta-acetate (DTPA) deposition and 133Xe clearance (p = 0.001). Both the 81mKr peripheral distribution and Technegas peripheral deposition correlated negatively with increased obstruction, as measured by forced expiratory volume in 1 sec (FEV1). Peripheral deposition of the high-size 99mTc aerosol deposition correlated with the inspiration/expiration time ratio. In conclusion, 81mKr and 99mTc aerosols' lung scintigraphies do not reflect exactly the pulmonary ventilation as measured by 133Xe scintigraphy.
开展了一项研究，以调查81-亚稳态氪（81mKr）分布、大颗粒99-亚稳态锝（99mTc）气溶胶沉积和小颗粒99mTc气溶胶（锝气体）沉积对通过133-氙（133Xe）肺闪烁显像评估的肺通气的预测价值，并评估81mKr分布、99mTc气溶胶沉积与慢性阻塞性肺疾病（COPD）患者呼吸参数之间的相关性。纳入了20例COPD患者。依次进行了81mKr、133Xe和99mTc气溶胶肺闪烁显像。将81mKr分布和99mTc沉积与平衡时的133Xe分布以及133Xe清除率进行了比较。定义了81mKr和锝气体肺闪烁显像检测133Xe显示的通气改变的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。使用主成分分析描述了根据呼吸参数的81mKr分布和99mTc沉积。与133Xe分布相比，病情较重患者肺部上叶81mKr分布显著更高（p = 0.05），肺部下叶锝气体沉积显著更高（p = 0.0008），大颗粒99mTc气溶胶在肺部中央部分的沉积显著更高（p = 0.0001）。81mKr的PPV和NPV分别为0.54和0.58，锝气体的PPV和NPV分别为0.54和0.55。81mKr分布与133Xe清除率之间（p = 0.0001）、锝气体沉积与133Xe清除率之间（p = 0.0007）以及99mTc二乙烯三胺五乙酸（DTPA）沉积与133Xe清除率之间（p = 0.001）存在显著负相关。81mKr外周分布和锝气体外周沉积均与以第1秒用力呼气量（FEV1）衡量的阻塞增加呈负相关。大颗粒99mTc气溶胶沉积的外周沉积与吸气/呼气时间比相关。总之，81mKr和99mTc气溶胶肺闪烁显像并不能准确反映133Xe闪烁显像所测量的肺通气情况。
