Université Européenne de Bretagne, CHU de la Cavale Blanche, Brest, France; EA3878 (GETBO) IFR 148, CHU de la Cavale Blanche, Brest, France; Service de médecine nucléaire, CHU de la Cavale Blanche, Brest, France.
Université Européenne de Bretagne, CHU de la Cavale Blanche, Brest, France; EA4324 (ORPHY) IFR 148, Université de Brest, CHU de la Cavale Blanche, Brest, France; Département de cardiologie, CHU de la Cavale Blanche, Brest, France.
Chest. 2012 Feb;141(2):381-387. doi: 10.1378/chest.11-0090. Epub 2011 Aug 18.
Planar ventilation/perfusion (V/Q) lung scintigraphy is a validated tool for the diagnosis of pulmonary embolism (PE). Nevertheless, given the high rate of nonconclusive V/Q, further investigation is often necessary. V/Q single-photon emission CT (SPECT) scan could improve V/Q performance, but sparse data are available on its accuracy. This study assessed the diagnostic performance of V/Q SPECT scan in a cohort of consecutive patients with suspected PE.
Three hundred twenty-one consecutive patients with a clinical suspicion of PE were prospectively included. Patients suspected of having PE were managed according to a reference diagnostic strategy validated by a 3-month follow-up. In addition to the reference strategy, patients had a V/Q SPECT scan, the results of which were compared with the initial work-up results.
Prevalence of PE was 0 of 41 (0%; 95% CI, 0%-9%), six of 134 (4%; 95% CI, 2%-9%),15 of 36 (42%; 95% CI, 27%-58%), and 28 of 32 (88%; 95% CI, 72%-95%) in the normal, low,intermediate, and high V/Q SPECT scan probability groups, respectively. The combination of V/Q SPECT scan with clinical probability was diagnostic in 88% of patients.
V/Q SPECT scan results show satisfactory accuracy for PE diagnosis. Validation of dedicated interpretation criteria is required, followed by outcome studies that use V/Q SPECT scan as part of a diagnostic strategy to rule out PE.
ClinicalTrials.gov; No.: NCT01183026; URL: www.clinicaltrials.gov
平面通气/灌注（V/Q）肺闪烁显像术是诊断肺栓塞（PE）的一种经验证的工具。然而，鉴于 V/Q 结果不确定的比例较高，通常需要进一步的检查。V/Q 单光子发射 CT（SPECT）扫描可以提高 V/Q 的性能，但关于其准确性的数据很少。本研究评估了 V/Q SPECT 扫描在一组连续疑似 PE 患者中的诊断性能。
前瞻性纳入 321 例连续疑似 PE 的患者。根据经 3 个月随访验证的参考诊断策略对疑似 PE 的患者进行管理。除了参考策略外，患者还进行了 V/Q SPECT 扫描，将其结果与初始检查结果进行比较。
PE 的患病率分别为 41 例（0%；95%CI，0%-9%）、134 例（4%；95%CI，2%-9%）、36 例（42%；95%CI，27%-58%）和 32 例（88%；95%CI，72%-95%），V/Q SPECT 扫描概率分别为正常、低、中、高。V/Q SPECT 扫描与临床概率相结合，对 88%的患者具有诊断价值。
V/Q SPECT 扫描结果显示对 PE 诊断具有良好的准确性。需要验证专用的解释标准，然后进行使用 V/Q SPECT 扫描作为排除 PE 的诊断策略一部分的结局研究。
ClinicalTrials.gov；编号：NCT01183026；网址：www.clinicaltrials.gov
