放射性核素肺顯像

1、正常肺灌注顯像正常肺灌注顯像正常肺通氣顯像正常肺通氣顯像肺灌注顯像肺灌注顯像肺通氣顯像肺通氣顯像肺灌注顯像肺灌注顯像肺通氣顯像肺通氣顯像心臟擴大心臟擴大膈肌麻痹膈肌麻痹胸主動脈瘤胸主動脈瘤安裝起搏器安裝起搏器肺灌注顯像肺灌注顯像肺通氣顯像肺通氣顯像肺灌注顯像肺灌注顯像肺通氣顯像肺通氣顯像溶栓前溶栓前溶栓后溶栓后繼續(xù)抗凝繼續(xù)抗凝10個月個月消融術前消融術前消融術后消融術后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%，特異性：，特異性：96%Clin Nucl Med, 2009, 34: 424 Emerg

5、Med J 2006, 23: 12335歲女性乳腺接受歲女性乳腺接受10mGy照射，乳腺癌的患病危險增加照射，乳腺癌的患病危險增加14%。正常肺灌注正常肺灌注/通氣通氣SPECT顯像顯像J Nucl Med，2004，45：1501Nucl Med Commun 2010, 31: 82肺灌注肺灌注SPECT顯像與顯像與CTPA的融合技術的融合技術CTPAV/Q斷層顯像斷層顯像輻射劑量輻射劑量高高低低受到顯像劑時間限制受到顯像劑時間限制否否是是過敏反應過敏反應是是否否造影劑引發(fā)腎病造影劑引發(fā)腎病是是否否診斷其他疾病診斷其他疾病是，經常是，經常 很少很少用于需要隨訪的與肺栓塞不相關的疾病用于需

6、要隨訪的與肺栓塞不相關的疾病是，經常是，經常很少或否很少或否敏感度敏感度低低高高特異度特異度高高低低X線胸片異常病例是否影響其準確性線胸片異常病例是否影響其準確性不影響不影響有些患者影響有些患者影響孕婦患者可否實施孕婦患者可否實施否否是是診斷慢性肺栓塞的準確性診斷慢性肺栓塞的準確性低低高高用于隨診病例用于隨診病例困難，輻射劑量高困難，輻射劑量高容易，輻射劑量低容易，輻射劑量低COPD患者誤診為肺栓塞患者誤診為肺栓塞可能不會可能不會非常嚴重的病例會非常嚴重的病例會技術上實施的失敗率技術上實施的失敗率高高低低CTPA與與V/Q斷層顯像的比較斷層顯像的比較CTPA與與V/Q斷層顯像輻射劑量的比較斷層

7、顯像輻射劑量的比較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