Université Européenne de Bretagne, Université de Brest, EA3878 (GETBO) IFR 148, CHRU de Brest, Service de Médecine Nucléaire, Brest, France.
Université Européenne de Bretagne, Université de Brest, EA3878 (GETBO) IFR 148, CHRU de Brest, Service de Médecine Nucléaire, Brest, France.
Thromb Res. 2018 Mar;163:236-241. doi: 10.1016/j.thromres.2017.06.031. Epub 2017 Jun 27.
Although widely validated, current tests for pulmonary embolism (PE) diagnosis, i.e. computed tomography pulmonary angiography (CTPA) and V/Q planar scintigraphy, have some limitations. Drawbacks of CTPA include the radiation dose, some contra indications and a rising concern about a possible overdiagnosis/overtreatment of PE. On the other hand, V/Q planar scintigraphy has a high rate of non-diagnostic tests responsible for complex diagnostic algorithms. Since the PIOPED study, imaging equipment and radiopharmaceuticals have greatly evolved allowing the introduction of techniques that improve imaging of lung ventilation and perfusion. Single photon emission computed tomography (SPECT) and SPECT/CT techniques are already largely used in daily practice and have been described to have greater diagnostic performance and much fewer non-diagnostic tests as compared with planar scintigraphy. However, they have not yet been firmly validated in large scale prospective outcome studies. More recently, it has also been proposed to image pulmonary perfusion and ventilation using positron emission tomography (PET), which has an inherent technical superiority as compared to conventional scintigraphy and may provide new insight for pulmonary embolism. Regardless of modality, these new thoracic imaging modalities have to be integrated into diagnostic strategies. The other major challenge for venous thromboembolism diagnosis may be the potential additional value of molecular imaging allowing specific targeting of thrombi in order, for example, to differentiate venous thromboembolism from tumor or septic thrombus, or acute from residual disease. In this article, the new imaging procedures of lung ventilation perfusion imaging with SPECT, SPECT/CT and PET/CT are discussed. We also review the current status and future challenge of molecular imaging for the in vivo characterization of venous thromboembolism.
虽然目前用于诊断肺栓塞（PE）的检测手段（如计算机断层肺动脉造影（CTPA）和通气/灌注平面闪烁显像）已得到广泛验证，但它们仍存在一些局限性。CTPA 的缺点包括辐射剂量、部分禁忌症以及对可能过度诊断/过度治疗 PE 的担忧不断增加。另一方面，通气/灌注平面闪烁显像的非诊断性检测率较高，这导致诊断算法较为复杂。自 PIOPED 研究以来，成像设备和放射性药物得到了极大的发展，从而引入了一些可改善肺通气和灌注成像的技术。单光子发射计算机断层扫描（SPECT）和 SPECT/CT 技术已在日常实践中得到广泛应用，与平面闪烁显像相比，这些技术具有更高的诊断性能和更少的非诊断性检测。然而，它们尚未在大规模前瞻性结局研究中得到充分验证。最近，人们还提出使用正电子发射断层扫描（PET）来对肺灌注和通气进行成像，与传统的闪烁显像相比，PET 具有内在的技术优势，可能为肺栓塞提供新的见解。无论采用哪种方式，这些新的胸部成像方式都必须整合到诊断策略中。静脉血栓栓塞症诊断的另一个主要挑战可能是分子成像的潜在附加价值，这可以使血栓的靶向治疗成为可能，例如，将静脉血栓栓塞症与肿瘤或感染性血栓区分开来，或区分急性与残留疾病。在本文中，我们讨论了 SPECT、SPECT/CT 和 PET/CT 肺通气灌注成像的新成像程序。我们还回顾了分子成像在静脉血栓栓塞症体内特征描述方面的现状和未来挑战。
