Department of Clinical Physiology, Skåne University Hospital, Lund, Sweden.
Eur J Nucl Med Mol Imaging. 2013 Sep;40(9):1432-7. doi: 10.1007/s00259-013-2425-8. Epub 2013 May 8.
Ventilation/perfusion tomography (V/PSPECT), with new interpretation criteria and newer tracers for ventilation imaging, has markedly improved the diagnostic yield in acute pulmonary embolism (PE). Here, we evaluated the diagnostic performance of perfusion SPECT (PSPECT) without ventilation imaging.
We studied 152 patients with clinically suspected PE who had been examined with both V/PSPECT and multidetector computed tomographic angiography (MD-CTA). The diagnosis or exclusion of PE was decided by the referring clinician based on both the V/PSPECT and/or MD-CTA findings in combination with the clinical findings. PSPECT images were retrospectively examined by a physician with experience in the interpretation of planar perfusion scans who was blinded to clinical, V/PSPECT and MD-CTA data. PSPECT images were interpreted without the aid of chest radiography. All the patients who were deemed to have PE were given anticoagulant therapy.
Of the 152 patients, 59 (39%) received a final diagnosis of PE, and 19 (32%) had associated cardiopulmonary diseases such as pneumonia, COPD, or left heart failure. PSPECT correctly identified 53 (90%) of the 59 patients with PE. The specificity was 88 of 93 (95%). None of the PSPECT images was rated nondiagnostic. PSPECT yielded an overall diagnostic accuracy of 93% (95% confidence interval, CI, 87-96%). At the observed PE prevalence of 39 %, the positive and negative predictive values of PSPECT were 91% (95% CI, 80-97%) and 94% (95% CI, 86-97%), respectively.
In managing critically ill patients, PSPECT might be a valid alternative to V/PSPECT or MD-CTA since it was able to identify most patients with PE with a low false-positive rate and no inconclusive results.
通气/灌注断层扫描（V/PSPECT）采用新的解释标准和更新的通气成像示踪剂，极大地提高了急性肺栓塞（PE）的诊断率。在这里，我们评估了不进行通气成像的灌注 SPECT（PSPECT）的诊断性能。
我们研究了 152 例临床疑似 PE 患者，他们均接受了 V/PSPECT 和多排 CT 血管造影（MD-CTA）检查。PE 的诊断或排除由主治医生根据 V/PSPECT 和/或 MD-CTA 检查结果并结合临床发现来决定。PSPECT 图像由一位有平面灌注扫描解读经验的医生进行回顾性检查，该医生对临床、V/PSPECT 和 MD-CTA 数据均不知情。PSPECT 图像的解读不借助胸部 X 射线。所有被认为患有 PE 的患者均给予抗凝治疗。
在 152 例患者中，59 例（39%）最终被诊断为 PE，19 例（32%）患有肺炎、COPD 或左心衰竭等心肺疾病。PSPECT 正确识别了 59 例 PE 患者中的 53 例（90%）。特异性为 93（95%置信区间，88-95%）。没有一张 PSPECT 图像被评为无诊断价值。PSPECT 的总体诊断准确率为 93%（95%置信区间，87-96%）。在观察到的 PE 患病率为 39%的情况下，PSPECT 的阳性和阴性预测值分别为 91%（95%置信区间，80-97%）和 94%（95%置信区间，86-97%）。
在治疗危重症患者时，PSPECT 可能是 V/PSPECT 或 MD-CTA 的有效替代方法，因为它能够以较低的假阳性率识别出大多数 PE 患者，且无不确定结果。
