Department of Nuclear Medicine, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China; and.
Centre for Diagnosis and Management of Pulmonary Vascular Diseases, Department of Cardiology, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China.
J Nucl Med. 2020 Dec;61(12):1832-1838. doi: 10.2967/jnumed.120.243188. Epub 2020 Mar 20.
This study compared the diagnostic performance of ventilation-perfusion (V/Q) planar imaging and V/Q SPECT and determined whether combining perfusion SPECT with low-dose CT (Q-LDCT) may be equally effective in a prospective study of patients with chronic thromboembolic pulmonary hypertension (CTEPH). V/Q scanning is recommended for excluding CTEPH during the diagnosis of pulmonary hypertension (PH). However, V/Q planar imaging and V/Q SPECT have yet to be compared in patients with CTEPH. Patients with suspected PH were eligible for the study. PH attributable to left heart disease or lung disease was excluded, and patients whose PH was confirmed by right heart catheterization and who completed V/Q planar imaging, V/Q SPECT, Q-LDCT, and pulmonary angiography were included. V/Q images were interpreted and patients were diagnosed as instructed by the 2009 European Association of Nuclear Medicine guidelines, and pulmonary angiography analyses were used as a reference standard. A total of 208 patients completed the study, including 69 with CTEPH confirmed by pulmonary angiography. V/Q planar imaging, V/Q SPECT, and Q-LDCT were all highly effective for diagnosing CTEPH, with no significant differences in sensitivity or specificity observed among the 3 techniques (respective sensitivity and specificity: 94.20% and 92.81% for V/Q planar imaging, 97.10% and 91.37% for V/Q SPECT, and 95.65% and 90.65% for Q-LCDT). However, V/Q SPECT was significantly more sensitive (V/Q SPECT, 79.21%; V/Q planar imaging, 75.84% [ = 0.012]; Q-LDCT, 74.91% [ < 0.001]), and V/Q planar imaging was significantly more specific (V/Q planar imaging, 54.14%; V/Q SPECT, 46.05% [ < 0.001]; Q-LDCT, 46.05% [ = 0.001]) than the other 2 techniques for identifying perfusion defects in individual lung segments. Both V/Q planar imaging and V/Q SPECT were highly effective for diagnosing CTEPH, and Q-LDCT may be a reliable alternative method for patients who are unsuitable for ventilation imaging.
本研究比较了通气-灌注（V/Q）平面显像和 V/Q 单光子发射计算机断层扫描（SPECT）的诊断性能，并在慢性血栓栓塞性肺动脉高压（CTEPH）患者的前瞻性研究中，确定了灌注 SPECT 联合低剂量 CT（Q-LDCT）是否同样有效。V/Q 扫描用于排除肺动脉高压（PH）诊断中的 CTEPH。然而，在 CTEPH 患者中尚未比较 V/Q 平面成像和 V/Q SPECT。 疑似 PH 的患者有资格参加这项研究。排除由左心疾病或肺部疾病引起的 PH，并对通过右心导管检查确认 PH 且完成 V/Q 平面成像、V/Q SPECT、Q-LDCT 和肺动脉造影的患者进行了包括。V/Q 图像由经过专门培训的核医学医师进行解释，并根据 2009 年欧洲核医学协会指南进行诊断，以肺动脉造影分析作为参考标准。 共有 208 例患者完成了研究，其中 69 例经肺动脉造影证实为 CTEPH。V/Q 平面成像、V/Q SPECT 和 Q-LDCT 对诊断 CTEPH 均具有高度有效性，三种技术之间的敏感性或特异性无显著差异（分别为 V/Q 平面成像的敏感性和特异性为 94.20%和 92.81%，V/Q SPECT 的敏感性和特异性为 97.10%和 91.37%，Q-LDCT 的敏感性和特异性为 95.65%和 90.65%）。然而，V/Q SPECT 的敏感性显著更高（V/Q SPECT，79.21%；V/Q 平面成像，75.84%[=0.012]；Q-LDCT，74.91%[<0.001]），而 V/Q 平面成像对单个肺段灌注缺损的特异性显著更高（V/Q 平面成像，54.14%；V/Q SPECT，46.05%[<0.001]；Q-LDCT，46.05%[=0.001]）。 两种 V/Q 平面成像和 V/Q SPECT 对诊断 CTEPH 均具有高度有效性，对于不适合通气成像的患者，Q-LDCT 可能是一种可靠的替代方法。
