Gottschalk A, Stein P D, Henry J W, Relyea B
Michigan State University, East Lansing, USA.
Chest. 1996 Aug;110(2):392-4. doi: 10.1378/chest.110.2.392.
The purpose of this investigation was to determine the frequency of pulmonary embolism (PE) in a single lung that showed a normal ventilation/perfusion (V/Q) lung scan when the V/Q scan on the contralateral side was interpreted as non-high-probability for PE.
Data are from the national collaborative study Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED). PE was diagnosed or excluded in all lungs by pulmonary angiography.
Single lungs with no V/Q abnormalities, when the V/Q scan on the contralateral side was interpreted as non-high-probability for PE, showed PE in 2 of 19 (11%) (95% confidence interval [CI], 1 to 33%). If PE was excluded by angiography on the side of the abnormal V/Q scan, then PE on the side of the normal V/Q scan was shown in only 1 of 19 (5%) (95% CI, 0 to 26%).
A normal V/Q scan in a single lung, when the contralateral lung was interpreted as non-high-probability for PE, did not completely exclude PE on the apparently normal side. In such lungs, the probability of PE was in the range of low-probability interpretations. If the pulmonary angiogram showed no PE on the side of the abnormal V/Q scan, the probability of PE on the side of the normal V/Q scan satisfied the definition of very low probability for PE. This observation in patients undergoing pulmonary angiography may assist in determining whether the pulmonary angiogram should be bilateral.
本研究的目的是确定在对侧肺通气/灌注（V/Q）扫描结果被判定为肺栓塞（PE）非高概率时，单肺V/Q扫描正常的情况下PE的发生频率。
数据来自全国性合作研究“肺栓塞诊断前瞻性调查（PIOPED）”。通过肺血管造影对所有肺进行PE的诊断或排除。
当对侧肺的V/Q扫描被判定为PE非高概率时，19例单肺V/Q扫描无异常的患者中有2例（11%）（95%置信区间[CI]，1%至33%）显示有PE。如果在V/Q扫描异常侧通过血管造影排除了PE，那么在V/Q扫描正常侧仅19例中有1例（5%）（95%CI，0至26%）显示有PE。
当对侧肺被判定为PE非高概率时，单肺V/Q扫描正常并不能完全排除看似正常一侧的PE。在这类肺中，PE的概率处于低概率判定范围内。如果肺血管造影显示V/Q扫描异常侧无PE，那么V/Q扫描正常侧PE的概率符合PE极低概率的定义。对接受肺血管造影的患者的这一观察结果可能有助于确定是否应进行双侧肺血管造影。
