Diagnostic Value Of SPECT/CT Radionuclide Pulmonary Ventilation/Perfusion Tomographic Fusion Imaging In Pulmonary Artery Thromboembolism

Objective: Studied in this paper through the lung ventilation/perfusion conventional 8-position planar imaging combined perfusion tomographic fusion imaging?V/Q+Q-SPECT/CT?compared with lung ventilation/perfusion tomographic fusion imaging?V/Q-SPECT/CT?to determine whether pulmonary ventilation SPECT/CT imaging can improve the diagnostic accuracy of pulmonary thrombolism?PE?,while comparing the two forms of inspection methods on the PE diagnostic performance.Methods:Selected 61 cases patients who were suspected with PE in our hospital,include 29 male patients and 32 female patients,age 31-75,average age?57.2±10.94?.All these cases took ventilation/perfusion imaging combined with perfusion SPECT/ CT imaging from 2016.1 to 2017.1 in our department.Among these patients 21 cases with elevated serum D-Dimer and all patients with PO₂ reduce.At the same time,choose 48 cases patients took ventilation SPECT/CT imaging from all patients above,age31-75,average age?55.08±10.82?,with 25 male cases and 23 female cases.Among those patients include 16 cases with increased serum D-Dimer,and all patients with PO₂ reduce.The study object of clinical data and related auxiliary examination is more perfect,and all the object of study has not been taking anticoagulant and thrombolytic therapy before been imaging.All images by two nuclear medicine physician who have rich experience in the diagnosis of PE reading alone.If you have the different diagnosis is decided by the superior doctors to read.Ventilation/perfusion SPECT/CT imaging in the diagnosis of PE standard combined with revised edition PIOPED and CT information,combined with the clinical symptoms,signs and other inspection diagnosis.Gold standard is clinical final diagnosis.To compare the differences between the two diagnostic methods and the gold standard,and whether the difference was statistically significant.At the same time to compare two diagnosis way of Sensitivity,Specificity,Accuracy?the total coincidence rate?,Positive Predictive Value?PPV?and Negative Predictive Value?NPV?;if P< 0.05,then we could think the difference had statistically significant.Statistical methods using ?² test to P <0.05 for the difference was statistically significant.At the same time,the ROC curve was used to compare the diagnostic efficacy of the two methods.Results:In 61 cases of the object of study,the clinical diagnosis of PE 32 cases,accounting for 52.5%?32/61?,and negative 29 cases.Based on V/Q+Q-SPECT/CT imaging results,diagnosis of PE height of the possibility of 29 cases,the possibility of 14 cases of moderate,low probability of 18 cases,according to diagnostic criteria diagnosis of PE positive 43 cases,70.5%?43/61?,negative 18 cases,among them true positive 29 cases,true negative 15 cases,false positive 14 cases and false negative 3 cases,the diagnostic specificity was 51.7%,the sensitivity was 90.6%,the positive predictive value was 67.4%,the negative predictive value was 83.3% and the total diagnostic coincidence rate was 72.1%.Forty-eight patients underwent V-SPECT/CT imaging in 27 patients?27/48?with positive clinical diagnosis and 21 negative patients.According to the results of V/Q-SPECT/CT imaging,17 cases were diagnosed with high probability of PE,8 cases with moderate possibility and 23 cases with low probability,25 cases were positive,accounting for 52.1%?25/48?,negative for 23 cases,23 cases of true positive,true negative 21 cases,2 cases were false positives,false negatives in 2 cases,the diagnostic specificity was 91.3%,the sensitivity was 92%,the positive predictive value was92%,the negative predictive value was 91.3% and the total diagnostic coincidence rate was 91.7%.In the diagnosis of PE,diagnosis of pleural effusion in 3 cases,pulmonary hypertension in 1 case,7 cases of pulmonary parenchymal lesions?including emphysema in 2 cases,1 case of expansion and infection,pneumonia in 4 cases?pericardial effusion1 case,and V/Q-SPECT/CT imaging diagnosed COPD 6 cases.Gold standard is clinical final diagnosis.The V/Q+Q-SPECT/CT imaging compared with gold stangard,P=0.013,and the difference was statistically significant.Pulmonary V/Q-SPECT/CT imaging was correlated with gold Standard comparison,P=0.687,do not think the difference between the two statistically significant.To compare V/Q+Q-SPECT/CT tomographic fusion imaging with V/Q-SPECT/CT tomographic fusion imaging,sensitivity ?²=0.414,P=0.52,specificity ?²=9.433,P=0.002,positive predictive value of ?²=5.299,P=0.021,negative predictive value of ?²=0.599,P=0.439,the total coincidence rate ?²=6.591,P=0.01.By statistical analysis of two kinds of examination ways in the diagnosis of PE specificity,positive predictive value and the total coincidence rate is in line with P<0.05,it is proposed that the two types of inspection of the above indexes difference was statistically significant.At the same,using ROC curve to compare these two way of diagnosis efficiency in PE,the area under the ROC curve of V/Q+Q-SPECT/CT tomographic fusion imaging was 0.712 and the area under the ROC curve of V/Q-SPECT/CT tomographic fusion imaging was 0.917,and 95% confidence interval were?0.578,0.846?and?0.813,1.000?.Conclusions:1This study shows that: pulmonary ventilation/perfusion imaging of the diagnosis of PE has a good value.Pulmonary V/Q-SPECT/CT imaging is one of the most common methods for the diagnosis of PE compared with clinical diagnosis.2Pulmonary V-SPECT/CT imaging can improve the sensitivity,specificity,positive predictive value,negative predictive value and total compliance rate of PE,and the difference between the specificity,the positive predictive value and the total coincidence rate learning meaning.3This study demonstrates that the diagnostic efficacy of pulmonary V/Q-SPECT/CT imaging is superior to that of pulmonary V/Q+Q-SPECT/CT tomographic fusion imaging?0.917vs0.712?,but due to the study cycle,sample size and other factors,the calculated statistical data no statistical difference.