Mazurek Andrzej, Dziuk Miroslaw, Witkowska-Patena Ewa, Piszczek Stanislaw, Gizewska Agnieszka
Department of Nuclear Medicine, Military Institute of Medicine, Warsaw, Poland.
Respiration. 2015;90(5):393-401. doi: 10.1159/000439543. Epub 2015 Sep 30.
Pulmonary embolism (PE) is diagnosed either by ventilation/perfusion (V/Q) scintigraphy or pulmonary CT angiography. One of the imaging methods used in nuclear medicine is hybrid SPECT/CT scintigraphy.
The aim of this study was to evaluate the utility of SPECT/CT(Q) scintigraphy in the diagnosis of PE and to compare SPECT/CT(Q) with planar(Q) and SPECT(Q) methods.
The study group consisted of 109 consecutive patients suspected of having PE referred for performing lung scintigraphy. The inclusion criteria were: performance of perfusion planar, SPECT and SPECT/CT scans; availability of clinical data covering a 6-month follow-up period, and D-dimer level testing. The number of eligible patients was 84. PE was reported in patients with at least 1 segmental or 2 subsegmental perfusion defects without parenchymal abnormalities on CT scans. PE was excluded when there was a normal perfusion pattern or perfusion defects were caused by lung parenchymal abnormalities or were not arranged in accordance with the pulmonary vasculature.
Twenty-six patients (31%) had a final diagnosis of PE. The sensitivity and specificity values of each method were as follows: planar(Q) 73 and 43%, SPECT(Q) 88 and 47% and SPECT/CT(Q) 100 and 83%. SPECT/CT(Q) yielded a significantly higher diagnostic accuracy than planar(Q) (p < 0.001) and SPECT(Q) (p < 0.001) scans.
We conclude that hybrid SPECT/CT(Q) imaging has a high diagnostic efficacy in the diagnosis of PE. Lung perfusion scintigraphy performed with a hybrid SPECT/CT device has a significantly higher sensitivity and specificity than scanning performed with the planar or SPECT technique.
肺栓塞（PE）可通过通气/灌注（V/Q）闪烁扫描或肺部CT血管造影进行诊断。核医学中使用的成像方法之一是SPECT/CT混合闪烁扫描。
本研究的目的是评估SPECT/CT（Q）闪烁扫描在PE诊断中的效用，并将SPECT/CT（Q）与平面（Q）和SPECT（Q）方法进行比较。
研究组由109例连续怀疑患有PE并被转诊进行肺部闪烁扫描的患者组成。纳入标准为：进行灌注平面、SPECT和SPECT/CT扫描；有涵盖6个月随访期的临床数据，以及D-二聚体水平检测。符合条件的患者有84例。对于CT扫描显示至少有1个节段性或2个亚节段性灌注缺损且无实质异常的患者报告为PE。当灌注模式正常或灌注缺损由肺实质异常引起或不符合肺血管分布时排除PE。
26例患者（31%）最终诊断为PE。每种方法的敏感性和特异性值如下：平面（Q）73%和43%，SPECT（Q）88%和47%，SPECT/CT（Q）100%和83%。SPECT/CT（Q）的诊断准确性明显高于平面（Q）（p<0.001）和SPECT（Q）（p<0.001）扫描。
我们得出结论，SPECT/CT（Q）混合成像在PE诊断中具有较高的诊断效能。使用SPECT/CT混合设备进行的肺灌注闪烁扫描比使用平面或SPECT技术进行的扫描具有明显更高的敏感性和特异性。
