放射性核素肺显像

1、正常肺灌注显像正常肺灌注显像正常肺通气显像正常肺通气显像肺灌注显像肺灌注显像肺通气显像肺通气显像肺灌注显像肺灌注显像肺通气显像肺通气显像心脏扩大心脏扩大膈肌麻痹膈肌麻痹胸主动脉瘤胸主动脉瘤安装起搏器安装起搏器肺灌注显像肺灌注显像肺通气显像肺通气显像肺灌注显像肺灌注显像肺通气显像肺通气显像溶栓前溶栓前溶栓后溶栓后继续抗凝继续抗凝10个月个月消融术前消融术前消融术后消融术后J Nucl Med 1993;34:1119-1126J Nucl Med 2008; 49:17411748Near-normal perfusion scan in a patient with postischemic

2、chronic left heart failure. (A) The pulmonary blood flow is distributed predominantly to upper and anterior regions; (B) CXR shows enlarged heart, dilated upper lobe vessels, and mild interstitial edema.Abnormal perfusion scan in a patient with COPD and moderate emphysema. (A) The scintigraphic outl

3、ine of the lungs is ill-defined with non segmental bilateral perfusion defects predominantly in upper lung regions; (B) posteroanterior and lateral CXRs show clear signs of emphysema predominantly in upper lung lobes.Lung cancer in a patient with no history of COPD. (A) a single nonsegmental perfusi

4、on defect is seen in the posterior regions of the right lung; (B) posteroanterior and lateral CXRs show a rounded sharply defined opacity in the costo-vertebral region of the right lung.J Nucl Med 2008, 49: 1741N Engl J Med 2006, 354: 22CTPA敏感性：敏感性：83%，特异性：，特异性：96%Clin Nucl Med, 2009, 34: 424 Emerg

5、Med J 2006, 23: 12335岁女性乳腺接受岁女性乳腺接受10mGy照射，乳腺癌的患病危险增加照射，乳腺癌的患病危险增加14%。正常肺灌注正常肺灌注/通气通气SPECT显像显像J Nucl Med，2004，45：1501Nucl Med Commun 2010, 31: 82肺灌注肺灌注SPECT显像与显像与CTPA的融合技术的融合技术CTPAV/Q断层显像断层显像辐射剂量辐射剂量高高低低受到显像剂时间限制受到显像剂时间限制否否是是过敏反应过敏反应是是否否造影剂引发肾病造影剂引发肾病是是否否诊断其他疾病诊断其他疾病是，经常是，经常 很少很少用于需要随访的与肺栓塞不相关的疾病用于需

6、要随访的与肺栓塞不相关的疾病是，经常是，经常很少或否很少或否敏感度敏感度低低高高特异度特异度高高低低X线胸片异常病例是否影响其准确性线胸片异常病例是否影响其准确性不影响不影响有些患者影响有些患者影响孕妇患者可否实施孕妇患者可否实施否否是是诊断慢性肺栓塞的准确性诊断慢性肺栓塞的准确性低低高高用于随诊病例用于随诊病例困难，辐射剂量高困难，辐射剂量高容易，辐射剂量低容易，辐射剂量低COPD患者误诊为肺栓塞患者误诊为肺栓塞可能不会可能不会非常严重的病例会非常严重的病例会技术上实施的失败率技术上实施的失败率高高低低CTPA与与V/Q断层显像的比较断层显像的比较CTPA与与V/Q断层显像辐射剂量的比较断层

7、显像辐射剂量的比较M/33LET=11 Sec MPAP=12mmHg 80706050403020100MPAP ( mmHg )70.0060.0050.0040.0030.0020.0010.000.00LET ( S )r=0.827, P0.001Receiver operating characteristic (ROC) analysis of LET for diagnosing pulmonary hypertension. The area under the curve (AUC) of LET for diagnosis of pulmonary hypertension was 0.886. At a cutoff value of LET at 22.7 s, the sensitivity and specificity for diagnosing pulmonary hypertension with DPPI were 94.7% and 78.0%, respectively.M/54