Study Of Comparing The Pulmonary Embolism Diagnosis Of Pulmonary V/Q Planarimaging, Pulmonary Q-SPECT/CT And CTPA

Objective:To study the value in the diagnosis of pulmonary embolism(PE) among traditional pulmonary ventilation-perfusion(V/Q) planar imaging and pulmonary perfusion SPECT combining with low-dose CT( Q-SPECT/CT) and CTPA.Methods:pulmonary V/Q planar imaging and pulmonary Q-SPECT/CT were performed in 4days before or after CTPA performed in 33 clinical PE-suspected patients and 28PE-reviewed patients.Images were read independently by relevant professional physician.Then taking Clinical diagnosis results as gold standards, finding out the index of diagnosis effectiveness about the above-mentioned methods as sensitivity, specificity and accuracy and the like and drawing ROC curve and comparing and analyzing the area under the ROC curve in pair.Carrying out Friedman test to the cumulative number of pulmonary segment and subsegment detected by the three methods and comparing and analysing them in pair.Results:1.33 PE-suspected patients: 23 were confirmed, 10 excluded.Area under the curve of CTPA being the largest, the clinical diagnosis accuracy of CTPA in APE was higher.Area of pulmonary V/Q planar imaging was the smallest. The clinical diagnosis accuracy was lower. While the accuracy of pulmonary V/Q planar imaging was moderate. Area of CTPA and pulmonary V/Q in patients with APE were compared. CTPA in clinicaldiagnosis accuracy is superior to pulmonary V/Q planar imaging, and the differences were statistically significant(P < 0.05). Comparing the area under the curve of pulmonary Q-SPECT/CT and pulmonary V/Q planar imaging,the differences were not statistically significant(P > 0.05).Comparing the cumulative number of pulmonary segment and subsegment detected by CTPA and pulmonary V/Q, the differences were statistically significant(P< 0.05). It means that for PE-suspected patients, the cumulative pulmonary segment number detected by CTPA was higher than that detected by pulmonary V/Q, while the cumulative pulmonary subsegment number detected by CTPA was lower. Comparing the two nuclear medicine methods, P>0.05, the differences were not statistically significant.2.28 PE-reviewed patients:19 were confirmed, 9 excluded.Area of CTPA being the smallest, the PE-reviewed diagnosis accuracy of CTPA was lower. Area of pulmonary V/Q planar imaging was the largest and the PE-reviewed diagnosis accuracy of pulmonary V/Q planar imaging was moderate as well as the pulmonary Q-SPECT/CT.Comparing the three methods in pair, the differences were not statistically significant(P > 0.05).Comparing the cumulative number of pulmonary segment and subsegment detected by CTPA and pulmonary V/Q, the differences were statistically significant(P < 0.05). It meant that for PE-reviewed patients, the cumulative number of pulmonary segment and subsegent detected by pulmonary V/Q was higher than that detected by CTPA.Comparing the two nuclear medicine methods, P>0.05, the differences were not statistically significant.3.all 61 PE patients: 42 were confirmed, 19 excluded.Area under the curve of pulmonary V/Q planar imaging was the smallest, while pulmonary Q-SPECT/CT the largest. The clinical diagnosis accuracy of the three methods for all the PE patients was moderate. Comparing the three methods in pair, the differences were not statistically significant difference(P>0.05).Comparing the cumulative number of pulmonary segment and subsegment detected by CTPA and pulmonary V/Q in all PE patients, the differences were statisticallysignificant(P<0.05). It meant that for all PE patients, the cumulative pulmonary segment number detected by CTPA is higher than that detected by pulmonary V/Q, while the cumulative pulmonary subsegment number detected by CTPA is lower.Comparing the two nuclear medicine methods, P>0.05, the differences were not statistically significant.Conclusion:1.pulmonary V/Q planar imaging and pulmonary Q-SPECT/CT and CTPA have their own characteristics.CTPA have advantages of embolus in pulmonary segment and more large pulmonary arteries,while pulmonary V/Q imaging have advantages of lesions in small pulmonary arteries and peripheral region.exclude the influence of uncertainty result,accuracy of diagnosis of acute PE of CTPA was higher than pulmonary V/Q planar imaging.2.For PE-reviewed patients,The cumulative number of pulmonary segment and subsegent detected by pulmonary V/Q was higher than that detected by CTPA.Compared with the latter, the former can provide more information on tissue perfusion functional improvement for PE-reviewed patients.3.Although scan CT can identify lung nonspecific lesions,clinical diagnosis accuracy, the cumulative number of pulmonary segment and subsegent detected by pulmonary Q-SPECT/CT and pulmonary V/Q planar imaging have no obvious differences, therefore it was improper to substitute pulmonary Q-SPECT/CT for pulmonary V/Q planar imaging to diagnose PE.