Drubach Laura A, Jenkins Kathy J, Stamoulis Catherine, Palmer Edwin L, Lee Edward Y
1 Department of Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave, Boston, MA 02466.
2 Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, MA.
AJR Am J Roentgenol. 2015 Oct;205(4):873-7. doi: 10.2214/AJR.14.13581.
The purpose of this study was to evaluate the utility of radionuclide perfusion lung scanning in the evaluation of primary pulmonary vein stenosis (PVS) in pediatric patients by comparing it with angiography.
We retrospectively identified pediatric patients with primary PVS who underwent both lung scanning and angiography. A cohort of 34 patients was evaluated. The presence of PVS in the right upper, right lower, left upper, and left lower pulmonary veins on angiograms was recorded. Two nuclear medicine physicians evaluated the lung scans for perfusion defects. Agreement between lung scan and angiographic findings was assessed with contingency tables. Sensitivity and specificity of lung scanning for accurate detection of PVS with angiographic findings as the reference standard were assessed by ROC analysis.
Angiography depicted PVS in 90 of the total 136 pulmonary veins (66%). Lung scans correctly depicted 65 (72%) of the cases of PVS diagnosed with angiography. The sensitivity and specificity of lung scans were 76.0% and 88.9% for the right upper pulmonary vein, 70.6% and 94.1% for the right lower pulmonary vein, 77.3% and 58.3% for the left upper pulmonary vein, and 65.4% and 87.5% for the left lower pulmonary vein.
Lung scan findings correlate with angiographic findings in the detection of primary PVS in pediatric patients. Perfusion lung scanning may have a role in angiographically diagnosed PVS by noninvasively showing relative perfusion at the tissue level.
本研究的目的是通过与血管造影术比较，评估放射性核素灌注肺扫描在评估儿科患者原发性肺静脉狭窄（PVS）中的效用。
我们回顾性地确定了同时接受肺扫描和血管造影术的原发性PVS儿科患者。对34例患者进行了评估。记录血管造影图上右上、右下、左上和左下肺静脉中PVS的存在情况。两名核医学医师评估肺扫描的灌注缺损情况。用列联表评估肺扫描与血管造影结果之间的一致性。以血管造影结果为参考标准，通过ROC分析评估肺扫描对准确检测PVS的敏感性和特异性。
血管造影显示136条肺静脉中有90条存在PVS（66%）。肺扫描正确显示了血管造影诊断的65例（72%）PVS病例。右上肺静脉肺扫描的敏感性和特异性分别为76.0%和88.9%，右下肺静脉为70.6%和94.1%，左上肺静脉为77.3%和58.3%，左下肺静脉为65.4%和87.5%。
在检测儿科患者原发性PVS方面，肺扫描结果与血管造影结果相关。灌注肺扫描可能通过在组织水平上无创显示相对灌注，在血管造影诊断的PVS中发挥作用。
