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目的评价核素肺通气/灌注(V/Q)显像对不典型亚肺段肺栓塞(PE)的诊断价值。方法患者141例,男58例,女83例,年龄(65.67±11.29)岁,其中下肢静脉病变史者14例,糖尿病、高脂血症史者45例,63例近期内行有创性诊断和治疗,另19例均无上述病史或诊疗史。所有患者行常规~(99)Tc~m-MAA 和~(99)Tc~m 气体显像后进行1～24个月的抗凝治疗,于治疗后再行肺灌注显像。将抗凝治疗前后肺灌注显像进行对比分析,根据肺内放射性分布的变化判断治疗效果,再结合临床资料及其他影像检查综合判断不典型 PE 的诊断。结果 141例患者肺灌注显像均显示某个肺野内不呈肺段或亚肺段分布的片状或小斑片状放射性分布稀疏区。肺通气显像示肺野内放射性分布基本均匀,未见放射性分布稀疏区。治疗后118例肺灌注显像显示双肺内放射性分布不同程度的增多或均匀。按肺野内放射性分布改善情况标准评价:抗凝治疗后恢复正常35例,显效49例,有效34例,总有效率为83.69%(118/141)。另23例肺内放射性分布无明显变化,视为无效。结论 V/Q 显像是诊断不典型亚肺段 PE 的首选方法。
Objective To evaluate the value of radionuclide / perfusion (V / Q) imaging in the diagnosis of atypical sub pulmonary pulmonary embolism (PE). Methods 141 patients, 58 males and 83 females, aged (65.67 ± 11.29) years old, of which 14 cases of history of venous leg disease, diabetes, hyperlipidemia in 45 cases, 63 cases of recent invasive diagnosis and The other 19 cases had no history or history of treatment. All patients underwent conventional anticoagulation after ~ (99) Tc ~ m-MAA and ~ (99) Tc ~ m gas imaging for 1 ~ 24 months, and then lung perfusion imaging was performed after treatment. The lung perfusion imaging before and after anticoagulant therapy were compared and analyzed, and the therapeutic effect was judged according to the change of radioactive distribution in the lung. Combined with clinical data and other imaging examinations, the diagnosis of atypical PE was concluded. Results The lung perfusion imaging in 141 patients showed sparse patchy or small patchy sparse distribution of radioactivity in the non-pulmonary or sub-pulmonary segments in one lung field. Pulmonary ventilation showed that the distribution of radioactive lung field was basically uniform, no sparse radioactive distribution area. After treatment, 118 cases of lung perfusion imaging showed different degrees of increase or even distribution of radioactivity in both lungs. According to the criteria for improvement of radioactive distribution in the lung field, 35 cases returned to normal after anticoagulation therapy, 49 cases were markedly effective and 34 cases were effective. The total effective rate was 83.69% (118/141). The other 23 cases of lung radiation distribution no significant change, as invalid. Conclusion V / Q imaging is the first choice for the diagnosis of atypical sub-pulmonary PE.