李杰 陈殿森 彭楠

[摘要] 近年来，随着影像诊断技术的更新换代及综合运用，肺栓塞的诊断率得以大幅度提升，但常见肺栓塞的影像检查仍存在一些局限性。自从肺栓塞诊断前瞻性研究（PIOPED）确立以来，成像设备和放射性药物就开始快速发展并进一步完善了肺通气和灌注成像的技术。单光子发射计算机断层成像术（SPECT）和SPECT/CT技术已经广泛应用在日常实践中。近来有人提出使用正电子发射计算机断层扫描（PET）来对肺灌注和通气进行成像，然而尚未在大规模的前瞻性结果研究中得到明确的证实。本文将对V/Q SPECT、V/Q SPECT/CT和V/Q PET/CT等各种影像检查方法进行讨论，并对分子成像在静脉血栓栓塞体内特性研究中的现状及发展趋势进行总结。

[关键词] 肺栓塞;通气/灌注成像;分子成像

[中图分类号] R730.44 [文献标识码] A [文章编号] 1673-7210（2018）04（b）-0041-04

Current status and progress of nuclear medicine and molecular imaging in the diagnosis of pulmonary embolism

LI Jie CHEN Diansen PENG Nan

Department of Radiology， the First Affiliated Hospital， College of Clinical Medicine of He′nan University of Science and Technology， He′nan Province， Luoyang 471003， China

[Abstract] In recent years， with the renewal and comprehensive application of imaging diagnostic techniques， the diagnostic rate of pulmonary embolism has been greatly improved， but common pulmonary embolism （PE） still have some limitations. Since the prospective study of pulmonary embolism diagnosis （PIOPED） since its establishment， imaging equipment and radiopharmaceuticals have developed rapidly and further improved pulmonary ventilation perfusion （V/Q） imaging techniques. Single photon emission computed tomography （SPECT） combination of SPECT and low dose CT （SPECT/CT） has been widely used in daily practice. Positron emission computed tomography has recently been proposed （PET） lung perfusion/ventilation imaging， however， has not yet been clearly confirmed in large-scale prospective studies. In this paper， we will discuss various imaging methods such as V/Q SPECT， SPECT/CT and V/Q PET/CT， and summarize the present situation and development trend of molecular imaging in the study of in vivo characteristics of venous thromboembolism.

[Key words] Pulmonary embolism; Ventilation/perfusion imaging; Molecular imaging

隨着检查技术的不断提高，肺栓塞（pulmonary embolism，PE）的确诊率有了大幅度的提高，但漏诊和过度诊断都会产生不良后果。未经治疗的PE死亡率仍然很高，而抗凝治疗会导致患者有很大的出血风险[1]。V/Q断层显像是第一种非侵入性的PE诊断方法[2]，但此方法假阳性率较高，因此普及率近来有所下降。肺动脉造影（CTPA）是目前PE诊断中的最常用的检查方法，但此检查又有着较高的辐射剂量、禁忌证及肾功能损害等诸多缺点，另外亚段PE的影像诊断也是颇具争论的问题[3-4]。本文将讨论用SPECT结合CT以及PET进行肺通气/灌注研究的新方法，还将回顾总结分子成像在体内凝块特性研究中的现状和未来的发展。……