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目的 探讨肺V/Q SPECT显像与CTPA对PE,尤其是亚肺段PE的诊断价值.方法 前瞻性分析2013年12月至2014年12月间因可疑PE首次于首都医科大学附属北京安贞医院行肺V/Q SPECT显像的571例(男265例,女306例,年龄24～91岁)患者资料.结果依据欧洲核医学学会(EANM)制定的诊断标准分为确诊PE、排除PE和不确定诊断,并与临床最终诊断进行对比研究,计算显像诊断PE的各效能指标,绘制ROC曲线评价诊断效能.将77例同期行肺V/Q SPECT和CTPA检查患者的显像结果分别与临床最终诊断进行对比,应用Kappa检验分析2种诊断方法的一致性,采用Fisher确切概率法评价2种方法的诊断水平.绘制ROC曲线,计算各自AUC及95％ CI并比较.结果 571例肺V/Q SPECT显像患者中,94例诊断PE(其中8例为多发亚肺段PE),427例排除PE,50例不确定诊断.经临床综合分析,93例确诊PE(8例多发亚肺段PE全部确诊PE),478例排除PE.V/Q SPECT诊断PE的PPV为93.62％ (88/94),NPV为99.77％ (426/427),Ac为98.66％(514/521),Se为98.88％ (88/89),Sp为98.61％ (426/432),不确定诊断比例为8.76％(50/571);ROC曲线的AUC及95％ CI分别为0.985和0.971～ 1.000.77例同期行肺V/Q SPECT显像和CTPA检查的患者中,V/Q不匹配亚肺段52个,CTPA检出受累亚段级肺动脉1个.2种检查方法诊断PE的PPV分别为81.48％(22/27)和10/13,NPV分别为97.83％ (45/46)和81.97％ (50/61),Ac分别为91.78％(67/73)和81.08％ (60/74),Se分别为95.65％(22/23)和47.62％(10/21),Sp分别为90.00％(45/50)和94.34％ (50/53),不确定诊断比例分别为5.19％(4/77)和3.90％(3/77).2种方法一致性不高(Kappa=0.330,P＜0.05).在PE的诊断上,V/Q SPECT显像较CTPA更具优势(P＜0.05).两者ROC曲线的AUC及95％ CI分别为0.930和0.863～0.998、0.725和0.588～ 0.863,不具有相互重叠的区域.结论 肺V/Q SPECT显像对诊断PE具有较高的PPV、NPV和Ac,较低的不确定诊断比例,对于PE具有较高的诊断效能,特别是对亚肺段PE的诊断具有明显优势.“,”Objective To explore the diagnostic efficiency of pulmonary V/Q SPECT imaging and CTPA in evaluation of sub-segmental PE.Methods A total of 571 patients (265 males,306 females,age range:24-91 years) with suspected PE between December 2013 and December 2014 underwent pulmonary V/Q SPECT imaging for the first time in Beijing Anzhen Hospital.The results of V/Q SPECT were classified as definite PE,no PE and uncertain diagnosis based on V/Q SPECT diagnostic criteria set by the European Association of Nuclear Medicine (EANM).The V/Q SPECT results were compared with the clinical final diagnosis which was concluded from comprehensive analysis of clinical probability,laboratory examination,other imaging examinations and follow-up.ROC curve was used to evaluate the diagnostic efficiency.Imaging results of 77 cases who underwent both pulmonary V/Q SPECT imaging and CTPA were compared to clinical final diagnosis.Kappa test was used to analyze the consistency of the two imaging methods.Fisher exact test was used to compare the diagnosis of the two methods.AUC and 95％ CI in ROC curve were calculated and compared.Results Ninety-four patients were diagnosed as PE by V/Q SPECT imaging,including 8 multiple sub-segmental PE;427 had no PE,and 50 with uncertain diagnosis.Clinical final diagnosis showed that 93 cases were confirmed PE,including 8 multiple sub-segmental PE;478 cases were excluded.The diagnostic evaluation indexes of pulmonary V/Q SPECT imaging on PE were as follows:PPV 93.62％ (88/94),NPV 99.77％(426/427),Ac 98.66％(514/521),Se 98.88％(88/89),Sp 98.61％(426/432).The proportion of uncertain diagnosis was 8.76％ (50/571).AUC of ROC curve was 0.985 and 95％ CI was 0.971-1.000.In 77 cases who underwent pulmonary V/Q SPECT imaging and CTPA,V/Q mismatch was found in 52 pulmonary sub-segments and 1 sub-segment pulmonary artery was detected with CTPA.The PPV,NPV,Ac,Se,Sp of pulmonary V/Q SPECT imaging were 81.48％ (22/27),97.83％ (45/46),91.78％ (67/ 73),95.65％ (22/23),90.00％ (45/50) and those of CTPA were 10/13,81.97％ (50/61),81.08％ (60/ 74),47.62％ (10/21),94.34％ (50/53).The proportion of uncertain diagnosis of the two examinations were 5.19％ (4/77) and 3.90％ (3/77),respectively (Kappa =0.330,P＜ 0.05).Compared with CTPA,V/Q SPECT imaging was more valuable for PE diagnosis (Fisher exact test,P＜0.05).AUC and 95％ CI of pulmonary V/Q SPECT imaging in ROC curve were 0.930 and 0.863-0.998,and those of CTPA were 0.725 and 0.588-0.863.There was no overlapping area.Conclusions Compared to CTPA,pulmonary V/Q SPECT imaging has higher PPV,NPV and Ac in the diagnosis of PE.It could reduce the proportion of uncertain diagnosis and has a higher diagnostic efficacy in PE,especially in sub-segmental PE.