Hull R D, Hirsh J, Carter C J, Raskob G E, Gill G J, Jay R M, Leclerc J R, David M, Coates G
Chest. 1985 Dec;88(6):819-28. doi: 10.1378/chest.88.6.819.
Differing opinions about the value of ventilation-perfusion lung scanning have created controversy concerning the correct approach to the diagnosis of pulmonary embolism. In a prospective study of 305 consecutive patients with clinically suspected pulmonary embolism and abnormal perfusion lung scans, we evaluated the role of ventilation-perfusion lung scanning, pulmonary angiography, and objective testing for venous thrombosis in the diagnostic process. Segmental or greater perfusion defects with ventilation mismatch have a high probability (86 percent) of pulmonary embolism. Contrary to current clinical practice, however, the approach of ruling against pulmonary embolism by a "low probability" scan pattern is incorrect, even with an improved technique for ventilation imaging; the frequency of pulmonary embolism in these patients ranged from 25 to 40 percent. Objective testing for venous thrombosis provides a practical alternative to performing pulmonary angiography in the diagnostic work-up; by providing an endpoint for commencing anticoagulant therapy, a positive result obviates the need for further testing in 20 to 30 percent of patients.
对于通气-灌注肺扫描价值的不同观点引发了关于肺栓塞正确诊断方法的争议。在一项对305例连续临床疑似肺栓塞且灌注肺扫描异常患者的前瞻性研究中，我们评估了通气-灌注肺扫描、肺血管造影以及静脉血栓客观检测在诊断过程中的作用。节段性或更严重的灌注缺损且通气不匹配时，肺栓塞的可能性很高（86%）。然而，与当前临床实践相反，即使采用了改进的通气成像技术，通过“低概率”扫描模式排除肺栓塞的方法也是不正确的；这些患者中肺栓塞的发生率在25%至40%之间。静脉血栓的客观检测为诊断检查中进行肺血管造影提供了一种切实可行的替代方法；通过为开始抗凝治疗提供一个终点，阳性结果可使20%至30%的患者无需进一步检查。
