肺灌注SPECT/CT对不同Wells评分可疑肺栓塞的下肢深静脉血栓的诊断价值

doi:10.6040/j.issn.1671-7554.0.2014.872

山东大学学报（医学版） ›› 2015, Vol. 53 ›› Issue (6): 86-89.doi: 10.6040/j.issn.1671-7554.0.2014.872

肺灌注SPECT/CT对不同Wells评分可疑肺栓塞的下肢深静脉血栓的诊断价值

吴大勇¹, 张文艳¹, 房保栓², 邱刚², 边艳珠¹, 胡玉敬¹

1. 河北省人民医院核医学科, 河北石家庄 050051;
2. 河北省人民医院肿瘤科, 河北石家庄 050051

收稿日期:2014-11-26 修回日期:2015-02-28 发布日期:2015-06-10
通讯作者: 边艳珠。 E-mail:hyx8144@126.com E-mail:hyx8144@126.com
基金资助:
河北省医学科学研究重点课题计划(20130414)

Diagnostic value of pulmonary perfusion SPECT/CT for lower-limb deep-vein thrombosis cases of patient with suspected pulmonary embolism which had different Wells scores

WU Dayong¹, ZHANG Wenyan¹, FANG Baoshuan², QIU Gang², BIAN Yanzhu¹, HU Yujing¹

1. Department of Nuclear Medicine, People's Hospital of Hebei Province, Shijiazhuang 050051, Hebei, China;
2. Department of Oncology, People's Hospital of Hebei Province, Shijiazhuang 050051, Hebei, China

Received:2014-11-26 Revised:2015-02-28 Published:2015-06-10

摘要/Abstract

摘要： 目的探讨肺灌注SPECT/CT显像对不同Wells评分可疑肺栓塞的下肢深静脉血栓患者的诊断价值。方法选取行肺灌注SPECT/CT显像可疑肺栓塞的下肢深静脉血栓患者210例,根据《2008版欧洲急性肺栓塞诊断治疗指南》推荐的Wells评分标准进行评分,总分≥7分为高度危险,≥2分、<7分为中度危险,<2分为低度危险。根据评分分为高度危险组(n=89)、中度危险组(n=64)及低度危险组(n=57)。对患者肺灌注SPECT/CT图像回顾性分析,计算3组肺栓塞的阳性率,利用SPSS 17.0对3组数据进行行乘列表χ²检验。结果高度危险组阳性率为70.8%(63/89),中度危险组阳性率为29.7%(19/64),低度危险组阳性率为10.5%(6/57),3组阳性率差异有统计学意义(χ²=57.47, P<0.05)。结论可疑肺栓塞下肢深静脉血栓患者Wells评分为高度或中度危险时,推荐行肺灌注SPECT/CT检查明确是否存在肺栓塞,以指导进一步的临床决策。当Wells评分为低度危险时,可暂不进行肺灌注SPECT/CT检查。

关键词: 深静脉血栓形成, 肺栓塞, SPECT/CT, 诊断, 肺灌注显像

Abstract: Objective To explore the diagnostic value of pulmonary perfusion SPECT/CT for patients with lower-limb deep-vein thrombosis (DVT) who may have pulmonary embolism (PE) with different Wells scores. Methods The study included DVT patients (n=210) with suspected PE. According to the Wells scores recommended by the 2008 European Pulmonary Embolism Diagnosis Guideline, the patients were divided into the high risk group (score ≥ 7, n=89), moderate risk group (2≤ score <7, n=64) and low risk group (score < 2, n=57). The patients' pulmonary perfusion SPECT/CT images were retrospectively analyzed. The positive rates of the three groups were calculated. The data were analyzed with chi-square(χ²)test. Results The positive rate of the high, moderate and low risk group was 70.8% (63/89), 29.7% (19/64) and 10.5% (6/57), respectively. There were statistical differences among the groups (χ² = 57.47, P<0.05). Conclusion When DVT patients suspected of PE are diagnosed to have high risk or moderate risk by Wells scores, pulmonary perfusion SPECT/CT imaging should be recommended to confirm whether pulmonary embolism exists.

Key words: Pulmonary embolism, Pulmonary perfusion scintigraphy, Diagnosis, SPECT/CT, Deep venous thrombosis

中图分类号:

R574

吴大勇, 张文艳, 房保栓, 邱刚, 边艳珠, 胡玉敬. 肺灌注SPECT/CT对不同Wells评分可疑肺栓塞的下肢深静脉血栓的诊断价值[J]. 山东大学学报（医学版）, 2015, 53(6): 86-89.

WU Dayong, ZHANG Wenyan, FANG Baoshuan, QIU Gang, BIAN Yanzhu, HU Yujing. Diagnostic value of pulmonary perfusion SPECT/CT for lower-limb deep-vein thrombosis cases of patient with suspected pulmonary embolism which had different Wells scores[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2015, 53(6): 86-89.

参考文献

[1] 中华医学会心血管病学分会肺血管病学组. 急性肺血栓栓塞症诊断治疗中国专家共识[J]. 中华内科杂志, 2010, 49(1): 74-81.
[2] Kearon C. Natural history of venous thromboembolism[J]. Circulation, 2003, 107(23 Suppl 1): 22-30.
[3] Heit JA, Cohen AT, Anderson FA. Estimated annual number of incident and recurrent, non-fatsl and fatal venous thromboembolism (VTE) events in the US[J]. Blood, 2005, 106(2): 267.
[4] 吴大勇, 张文艳, 邱刚, 等. 肺灌注SPECT/CT显像对可疑肺栓塞患者的诊断价值[J]. 广东医学, 2014, 35(9): 1366-1368. WU Dayong, ZHANG Wenyan, QIU Gang, et al. The diagnostic value of pulmonary perfusion SPECT/CT in patients suspected pulmonary embolism[J]. Guangdong Medical Journal, 2014, 35(9): 1366-1368.
[5] Adam Torbicki, Chairperson, Arnaud Perrier, et al. Guidelines on the diagnosis and management of acute pulmonary embolism[J]. European Heart Journal, 2008, 29(18): 2276-2315.
[6] Wells PS, Anderson DR, Rodger M, et al. Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer[J]. Thromb Haemost, 2000, 83(3): 416-420.
[7] Delbeke D, Coleman RE, Guiberteau MJ, et al. Procedure Guideline for SPECT/CT Imaging 1.0[J]. J Nucl Med, 2006, 47(7): 1227-1234.
[8] Bajc M, Neilly JB, Miniati M, et al. EANM guidelines for ventilation/perfusion scintigraphy Part 2. Algorithms and clinical considerations for diagnosis of pulmonary emboli with V/P SPECT and MDCT[J]. Eur J Nucl Med Mol Imaging, 2009, 36(9): 1528-1538.
[9] Meneveau N, Seronde MF, Blonde MC, et al. Management of unsuccessful thrombolysis in acute massive pulmonary embolism[J]. Chest, 2006, 129(4): 1043-1050.
[10] 姚稚明, 王展. 肺通气灌注显像在肺栓塞临床处理过程中的应用价值[J]. 中华医学杂志, 2012, 92(26): 1813-1815.
[11] 王峰, 李全, 董薇, 等. 同机低剂量CT在肺通气/灌注SPECT显像诊断肺栓塞中的价值[J]. 中华核医学与分子影像杂志, 2011, 31(5): 320-323. WANG Feng, LI Quan, DONG Wei, et al. Additional diagnostic value of low dose CT in ventilation/perfusion hybrid SPECT for pulmonary embolism[J]. Chnia J Nucl Med, 2011, 31(5): 320-323.
[12] 吴大勇, 张文艳, 陈江红, 等. 肺灌注SPECT/CT评估肺栓塞治疗效果[J]. 中国医学影像技术, 2014, 30(4): 540-543. WU Dayong, ZHANG Wenyan, CHEN Jianghong, et al. Pulmonary perfusion SPECT/CT in evaluation on therapeutic effect of pulmonary embolism[J]. Chin J Med Imaging Technol, 2014, 30(4): 540-543.
[13] 张晶晶, 谢新立, 阮翘, 等. ⁹⁹Tc^m-MAA SPECT/CT融合显像与64排螺旋CT肺动脉成像诊断肺栓塞的对比研究[J]. 中华核医学与分子影像杂志, 2012, 32(2): 149-150.
[14] 吴大勇, 张文艳, 陈江红, 等. 肺灌注SPECT/CT显像对术后可疑肺栓塞患者的诊断价值[J]. 河北医药, 2014, 36(21): 3229-3231. WU Dayong, ZHANG Wenyan, CHEN Jianghong, et al. The diagnostic value of pulmonary perfusion SPECT/CT in post-operation patients suspected pulmonary embolism[J]. Hebei Medical Journal, 2014, 36(21): 3229-3231.

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肺灌注SPECT/CT对不同Wells评分可疑肺栓塞的下肢深静脉血栓的诊断价值

Diagnostic value of pulmonary perfusion SPECT/CT for lower-limb deep-vein thrombosis cases of patient with suspected pulmonary embolism which had different Wells scores

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