Begic Amela, Jögi Jonas, Hadziredzepovic Amra, Kucukalic-Selimović Elma, Begovic-Hadzimuratovic Sadzida, Bajc Marika
Clinic for Nuclear Medicine, Clinical Center, University Hospital of Sarajevo, Sarajevo, Bosnia.
Nucl Med Commun. 2011 Jun;32(6):508-14. doi: 10.1097/MNM.0b013e328344dfd5.
Pulmonary embolism (PE) is a severe condition with nonspecific symptoms. Diagnosis relies on medical imaging but follow-up is currently based on clinical symptoms and general risk factors. The duration of anticoagulant treatment after an acute episode of PE is still subject to debate and the best method of identifying the risk of recurrence in individual patients is undefined. Tomographic lung scintigraphy [ventilation/perfusion single photon emission computed tomography (V/P SPECT)] has improved the diagnostic accuracy with regard to PE but has not been evaluated for PE follow-up.
The aim of this prospective study was to quantitatively follow the natural history of treated PE using V/P SPECT, which could prove helpful in defining an anticoagulant treatment regime for individual patients.
Of 83 consecutive patients with clinically suspected PE examined with V/P SPECT, 23 patients with confirmed PE were followed by serial V/P SPECT examinations over a 6-month period. All patients were also followed clinically.
The mean relative decrease in PE extent compared with the time of diagnosis was 54±26% at 2 weeks, 79±30% at 3 months, and 82±30% at 6 months. Significant resolution of mismatched perfusion defects occurred between V/P SPECT controls within the first 3 months of anticoagulation (P<0.001) but not thereafter. V/P SPECT identified four patients with chronic PE, even though all patients were free from symptoms at 3-month follow-up.
Follow-up of PE with V/P SPECT is feasible to evaluate treatment effectiveness in individual patients and to identify patients that develop chronic PE. This study also confirms that resolution of perfusion defects after PE occurs within the first 3 months of treatment. It is therefore recommended that V/P SPECT follow-up should be considered at 3 months after diagnosis.
肺栓塞（PE）是一种症状不具特异性的严重疾病。诊断依赖医学影像检查，但目前的随访基于临床症状和一般风险因素。PE急性发作后抗凝治疗的持续时间仍存在争议，且确定个体患者复发风险的最佳方法尚不明确。断层肺闪烁扫描[通气/灌注单光子发射计算机断层扫描（V/P SPECT）]提高了PE的诊断准确性，但尚未用于PE的随访评估。
这项前瞻性研究的目的是使用V/P SPECT定量追踪已治疗PE的自然病程，这可能有助于为个体患者确定抗凝治疗方案。
在83例连续接受V/P SPECT检查的临床疑似PE患者中，23例确诊为PE的患者在6个月内接受了系列V/P SPECT检查。所有患者也进行了临床随访。
与诊断时相比，PE范围的平均相对减少在2周时为54±26%，3个月时为79±30%，6个月时为82±30%。抗凝治疗的前3个月内，V/P SPECT对照之间不匹配的灌注缺损有显著改善（P<0.001），但之后没有。V/P SPECT识别出4例慢性PE患者，尽管所有患者在3个月随访时均无症状。
用V/P SPECT对PE进行随访，对于评估个体患者的治疗效果和识别发生慢性PE的患者是可行的。本研究还证实，PE后灌注缺损的改善发生在治疗的前3个月内。因此，建议在诊断后3个月考虑进行V/P SPECT随访。
