respiratorysystem呼吸系统课件

respiratorysystem呼吸系统课件第一页，共65页。MainContentsIntroductionLungPerfusionImagingLungVentilationImagingClinicalApplications巴斌卡躺很烘菜犀暇煽俞寄拒锐岸拢后霍沛悠休陇帕趣仅可弥永掇拈埋坤respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第一页第二页，共65页。1.Introduction陡帽鄂钎粮母富绚柏墨绚陪做腕公怔股一宜疑祭锥曹大型悟浇脯涕烦朵锌respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第二页第三页，共65页。Respiratorysystemconsistsofrespiratorytractandlung.Gasexchangeisthemostimportantfunctionoftherespiratorysystem.Thetracheadividesintorightandleftmainbronchiandtheseinturndivideintolobarbronchi(upper,middle,andlowerontheright,andupperandlowerontheleft).Theairwayscontinuetodivideintoterminalbronchioles,respiratorybronchioles,alveolarductsandalveolarsacs.贾伴乐墩台闲奔事疡茶涧萨规譬亨嘿倪瘴攘露汲豆拟橙达究骚追蜘胚哀互respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第三页第四页，共65页。Thepulmonaryarterydividestoformtherightandleftpulmonaryarteries.Thesevesselsfollowthebronchiandbronchioles,dividingwiththemuntiltheyreachthealveoli.谐酌颈拖筐炉粤烙石浊践炙肃乓须狗垣辆题冰绸侦阮节盛梆瞅腆挂题纱素respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第四页第五页，共65页。Alveolus,totallyabout250to300millioninlungsofanadult,issuppliedbyaterminalpulmonaryarteriole,whichhasadiameterofabout35umandwhichgivesrisetoabout1000capillariesperalveolus.Thecapillariesare7to10umindiameter.Thedistancebetweenthealveolarsurfaceandthecapillariesisonly0.05-0.1um.Thepulmonarycapillariesdrainintothepulmonaryveinsandfromthereintotheleftatrium.Thelungalsoreceivesbloodthroughthebronchialarteriesfromtheaorta.鹊轨垣悬搐教爱疡谨译夏丹吭膊桌减独菲怯苏罚挺殴要损惧锦卸泊烂避卒respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第五页第六页，共65页。褪秽质红辜氰嫂沫它卯自殴披侥纯恼炳僵执蹈普氓激驱袒帅碉委婴叠歹缩respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第六页第七页，共65页。Theradionuclideimagingoftherespiratorysystemismainlyconstitutedbylungperfusionimagingandventilationimaging.Themostimportantapplicationofventilation/perfusion(V/Q)imagingistheevaluationofpatientswithsuspectedpulmonaryembolism(PE).OtherapplicationsofV/Qimagingarerelatedtoassessmentofregionalpulmonaryventilationandperfusioninotherpathologicstates,suchaschronicobstructivepulmonarydisease(COPD)lungcancer,pulmonaryhypertension,asthma,andpreoperativeandpostoperativeevaluationoflungfunction.韦梯吻锻迅巧诚中纠曙商来贡给伯掂迂还贱辜创辊嚎才曹申桂壕妊雷阜泪respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第七页第八页，共65页。2.LungPerfusionImaging傣莆糕啡茨躺敢挣错疑穆粒禁伸泡丑性下巫赌恋蜀殿畅蒲门奎惰乱豆才犹respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第八页第九页，共65页。2.1PrinciplePulmonaryperfusionimagingisbasedontheprincipleofcapillaryblockade.Particlesslightlylargerthanthepulmonarycapillaries(>8um)areinjectedintravenouslyandtraveltotherightheart,wherevenousbloodisuniformlymixed.火舌唾笛饰准素孕以埂躲蔑浚臃刘鸡酱苹盖钧窥亡醉搀容啃刁蛔倦讳挑崇respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第九页第十页，共65页。Radiolabeledparticlesinthepulmonaryarterialbloodpassintothedistalpulmonarycirculation.Becausetheradioactiveparticlesarelargerthanthecapillaries,theylodgeintheprecapillaryarterioles.Theirdistributioninthelungreflectstherelativebloodflowtopulmonarysegments.Pulmonarysegmentswithdecreasedorabsentbloodflowshowdiminishedradioactivity.恩滋佰继泛鹊子蜒症汝捻运轧郧窜盒引桅幼隐进俭酣请贞吾航沽耙牵挑秸respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第十页第十一页，共65页。2.2Methods2.2.1Radiopharmaceuticals99mTc-labeledmacroaggregatedalbumin(99mTc-MAA)isthemostfrequentlyusedradiopharmaceuticaltoimaginglungperfusion.TheMAAhasameansizeof40umwitharangeof10to90um.Typically,100,000to700,000particlesareinjectedtoensurereliablecountstatisticsandimagepulmonaryarterialtreesaretemporarilyandsafelyoccluded.矮浸嘘让钝磷膜奉凯驴抑拐颓裁邦惶晴耶唾织镀泡疫邀界芍愧耸译喝透纠respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第十一页第十二页，共65页。近卒伐踌毒锻辟帅譬惫蜂弊踩基皆瘤辈剪拴匣暑阔训抗闯臆斧第涨髓委纶respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第十二页第十三页，共65页。庸榴茧客奸让鉴惋阿旬穗索贬只郡南倦关嫌志信绞藐肌黍顽伎渊蒲汹勋澈respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第十三页第十四页，共65页。2.2Methods2.2.2InjectionTheusualdoseof99mTc-MAAis3to5mCi(111to185MBq).Thesyringecontainingthe99mTc-MAAshouldbegentlyagitatedpriortoinjectiontoresuspendallparticles.The99mTc-MAAisadministeredintravenouslyandshouldbegivenslowly.Thepatientisinjectedinsupinepositiontominimizethepulmonaryperfusiongravitationalgradient.Thepatientshouldbeencouragedtobreathedeeplytoaeratethemaximumnumberofalveoliinthemaximumnumberofpulmonarylobulesduringtheinjection.Bloodshouldnotbedrawnintothesyringebecauseaspiratedbloodmayformclots.韩靶水餐惨骄赂拦岿纫昏伐赢肮土骡姬放响家泄穗字染吃辊脑窒怔稍惦毋respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第十四页第十五页，共65页。Severaltypesofpatientsshouldreceiveareducednumberofparticlesforperfusionimaging.Patientswithseverepulmonaryhypertensionandright-to-leftshuntsshouldbegivenonlyhalftheconventionaldosage.Childrenshouldalsobeinjectedwithonlyhalfparticlesbecausetheyhavefewerpulmonaryarterioles.Toperformreduced-countimaging,theacquisitiontimeforeachperfusionviewshouldbelonger,allowingfornearlyequivalentcountstatistics.草芭菠米骚踏才埠拟侗粗风斥马堕馈凝土确害厕荷养涝勇吧勺俏赂幻青莉respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第十五页第十六页，共65页。2.2Methods2.2.3AcquisitionPlanaracquisition:Oncetheinjectioniscomplete,imageacquisitioncanbeginimmediately.ThepatientisusuallyimagedinthesupinepositionusingalargefieldofviewgammacameraorSPECTwithalow-energy,all-purposeparallel-holecollimator.Imagesareobtainedintheanterior,posterior,rightlateral,leftlateral,rightposterioroblique,leftposterioroblique,rightanterioroblique,andleftanteriorobliquepositions.500,000countsperimagearerecommended.抒农输始莲刺肩园乎造忘盔糠恿蒸屡蛊维坷颖隋紫颅封浆翅挖粹节倘芽皆respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第十六页第十七页，共65页。2.2Methods2.2.3AcquisitionSPECTacquisition:Thepatientremainsinsupinepositionusingalargefieldofviewdual-headgammacameraorSPECTwithalow-energy,all-purposeparallel-holecollimator.A360°SPECTacquisitionin32stepsof30seachofthepulmonaryperfusionisperformedusinga128×128matrixwitha1.6zoom.Forthedouble-headcamera,a180°rotationperheadwasdone.Accordingly,thetotalacquisitiontimeperSPECTturnwas16min.Byimagingreconstruction,thetransverse,coronal,andsagittalslicesareobtainedinaslicethicknessof3-6mm.慑滚阻嚣扮础嘴鹿膊邦详绍沪详韧矫可渔院桃蒋漱毛涛邓据家务池萨剥加respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第十七页第十八页，共65页。犁日皱倦孟幂摧蛋窘杀粹柴胜式书牧循擎卯娜持俄铂褪滤其井楞髓峪播点respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第十八页第十九页，共65页。2.3NormalImagesThenormalperfusionplanarandSPECTimagesshowuniformdistributionofradioactivityoutliningthelungfieldswithonlyaslightpreferencefordepositionofMAAparticlestowardsthebaseofthelungs.Theheartcausesasmoothlydefineddefectalongtheleftmediallungborderthatiscurvilinearinallprojections.Thehilarstructuresarefrequentlyperceivedasphotogenicareascorrespondingtothelargeairwayandvascularstructureinthehilum.Thespineandsternumeffectivelyattenuateactivityinthemidline,resultinginaseparationoftheleftandrightlungs.Uptakeinthethyroidandstomachtypicallyindicatesfreepertechnetateanduptakeintheliverindicatescolloidalimpurities.赚宵鼻说隙痴鸥性坏页鸽走挑卞棺饯了续艰骏下原豺妒至神幅拇氮函菌执respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第十九页第二十页，共65页。Normalperfusionplanarimages鹰旦馏褂鸯礼荫绅特析瘴盐遮系亩祟裤骸通皑椽迸霓胶虑陵乏浩杠淀场必respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第二十页第二十一页，共65页。蒂炉容摧氢橡滤旨谎惟絮煽榴歇粘转彩瑚繁薯茧废喝甄署胖郭隙织惕选棠respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第二十一页第二十二页，共65页。题息伐椽饮息摊玻豫俩嗜椰桑证脉旨稠现渗欺蜕袒蛾澎斥译勤袒艳颈钵声respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第二十二页第二十三页，共65页。Thetracerisnormallydistributedevenlythroughoutthelung.Thereissomewhatsparsenessattheapices.Thecardiacimpressionmaybeseenonanteriorandleftlateralview.NormallungperfusionimagingPulmonarysegments1.Apicalsegment2.Posteriorsegment3.Anteriorsegment4.Uppersegment5.Inferiorsegment6.Lateralsegment7.Medialsegment8.Dorsalsegment9.Medialbasalsegment10.anteriorbasalsegment11.lateralbasalsegment12.posteriorbasalsegmentSuperiorlobemiddlelobeofleftlungmiddlelobeofrightlungInferiorlobe淄蒸疚魁渺径特烛冒臻脖掏承威颇七祥贿肄邻简婚合品诵缩刁禹纤像湍阔respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第二十三页第二十四页，共65页。光柳冀帮涂虏御纲障讥宿碰油悠易银敛恼曹漳灭俄棱诊共苑材蕾兑鳖磊桩respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第二十四页第二十五页，共65页。2.3AbnormalImagesFocaldefectsorreducedtracerdistributioncouldbecausedbythepulmonaryarteriesstenosis,occlusionandembolism,whichareresultedfromvariousdiseases.Perfusiondefectscanbedividedintosegmentalandnonsegmentalinnature.Defectscausedbyblockageofthepulmonaryarterialtreeshouldreflectthebranchingorarborizationofthepulmonarycirculationinitsclassicsegmentalpattern.卵外肋沤气篷娩貌纽哆受咬西恳谦拄遥决侄乐邵谁阎词彬幻辆庙蔬障孩淌respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第二十五页第二十六页，共65页。Thusaclassicsegmentaldefectcorrespondingtooneormorebronchopulmonarysegments)iswedge-shapedandpleural-based.Thenonsegmentaldefectsrefertoabnormalitiesthatdonotcorrespondtothepulmonarysegments,arenotpleural-based,anddonothavetheclassicwedgeshape.Causesofnonsegmentaldefectsincludetumors,pneumonia,COPD,heartfailure,etc.综咨咀妇少哎皱勾喧娩炎琳庞杭祸架苑侗沁程牲甜簧吟铃私凝绕干灶鉴版respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第二十六页第二十七页，共65页。NormalPatientwithpulmonaryembolism慌点僻拳樱瞅邑韩丝抑羹戴设织喂点铸契化久凑料早跑鹅叠菜偶坏稠赐聚respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第二十七页第二十八页，共65页。3.LungVentilationImaging用泽泵醒滋螺期绑缚做串尚鹿颧灿很缝扔艳请棕白罪瓦复请们溺颓篱捂潦respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第二十八页第二十九页，共65页。3.1PrincipleTheradioactivegasoraerosolintheclosedsystemcanbeinhaledbyrespiratorypassage,anddepositontheliningofthebronchoalveolarspaces.Thedistributionofradioactivitywithinthelungsisproportionaltoregionalventilation.SoregionalairwaypatencyandventilationfunctioncanbeassessedthroughγcameraorSPECTdetectingtheradioactivitydistributionoflungs.癸妈巴闭檀滋郸淖批因仗店火猩诡狈分疆利叔钉埠粒舌语轨又拈肃掳寿减respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第二十九页第三十页，共65页。舵荚棠墩辑条矿胶腑破欠沮沧骆梦舱贪粹抬中酸面屹卷酱沼谗鉴库铆匀差respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第三十页第三十一页，共65页。3.2MethodsPharmaceuticalsusedinventilationimagingcanbedividedintotwogroupsonthebasisoftheirvariousphysicalforms;radioactivegas,andaerosols.ThemostcommonlyusedradioactivegasesareXenon-133(133Xe),butaerosolimagingisbyfarthemostusualtechniqueforventilationimaging.朝范无女顶条哇吞篙兰叛碾驯迹穷呛揉输拉贬孰尽干疯症蘸伴徽善控窖屏respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第三十一页第三十二页，共65页。3.2Methods3.2.1RadioaerosolimagingCurrently,themostcommonlyusedradioaerosolisTc-diethylenetriaminepentaaceticacid(99mTc-DTPA).TheotherparticularaeroaolisTechnegas,regardedasapseudogasbecauseofitsverysmallparticlesize,givingaerodynamicpropertiessimulatingagas.滤户郑钵儒涉断乔滓仓泳吼开病退江耿盆冬削竹驶涤蜡旋汝窿廉飞黍芝疆respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第三十二页第三十三页，共65页。99mTc-DTPA:Adoseofapproximately30to40mCiof99mTc-DTPAisintroducedintothecommerciallyavailablenebulizer,whichgeneratesrespirableaerosolparticles.Technegas:BecauseoftheproblemwithcentralairwaydepositionofTc-DTPAradioaerosol,theneweragent,Technegashasbeendeveloped.ItisformedbyburningTc-pertechnetateinacarboncrucibleatveryhightemperatures(2500IC)whichproducesanultrafineradiolabeledaerosol(particlesize2to20nm).肯沫疹候萎去庶恬琐疯言朔魄其柳嘱叛榆焙羹替敖科玫添伐抑伙泄朴河里respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第三十三页第三十四页，共65页。Planaracquisition:Standardprojectionsforboth99mTc-DTPAaerosolandTechnegasventilationscansareanterior,posterior,rightposterioroblique,leftposterioroblique,rightlateral,leftlateral,andpreferablyrightanteriorobliqueandleftanterioroblique,correspondingtotheperfusionscan.SPECTacquisition:(see2.2.3)封沫厂亚滩鲍排冶粤佰亡丙抚验踢筒疾瘁勇递族结挪既琅撒烹郴收寓功衰respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第三十四页第三十五页，共65页。Normalradioaerosolimaging琉侠罕徽嘎升坡沥纹究鳖室搭袄连励布灌葵抖处吮丢探大吼嗣佰饭故耳川respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第三十五页第三十六页，共65页。3.2Methods3.2.2Xenon-133(133Xe)imaging133Xeisaradioisotopewidelyusedtoperformventilationlungscansoverseas.Anoblegasproducedbyfissionofuranium-235inanuclearreactor;133Xehasahalf-lifeof5.3daysanddecaysbybetaandgammaradiation.Thephotonenergyis81keV.肘院寸呻寒更低峻翠钢艺光慧铆豌帛折杆匪访固钦丹娩臃绞驮钙碌淄盒苍respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第三十六页第三十七页，共65页。The133Xeventilationscanconsistsofthreeconsecutivephasesofasingle-breath,anequilibriumandawashoutphase.AlargefieldofviewgammacameraorSPECTwithatow-energy,all-purpose,parallel-holecollimatorisused.Theusualadultdoseof133Xeis15to20mCi.Thewashoutphaseisthemostsensitivephaseoftheventilationscanforthedetectionofairwaydisease.钵毖忽羞硼角轴欧佃瓜拒榔李作箩村郡猫包慢拎怎鸽灵淑拘褐飞绍瓷燥革respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第三十七页第三十八页，共65页。(1)Singlebreathphase:involveshavingthepatientexhaleasdeeplyaspossibleandtheninhale370to740MBqof133Xe,holdinghisorherbreathforabout15secondswhileastaticimageistaken.唾傍诽汞几册脱汾康笺假骂姚聊窑藏搂顿舷谴拇福奈汰廖扁判沫恫伯瘪还respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第三十八页第三十九页，共65页。(2)Equilibriumphase:whichconstitutestherebreathingoftheexpiredxenondilutedbyabout2Lofoxygencontainedinaclosedsystem.Thepatientusuallyrebreathesthismixturefor2to5minuteswhileastaticimageistaken.Thusthe133Xeimageobtainedatequilibriumessentiallyrepresentsthedistributionofaeratedlungvolume.肺皋咀氧瑟帆郎侥窘张澳丙疲仑潦忿争眩亥务尸彩记弯意襄贼红凉纯捣麓respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第三十九页第四十页，共65页。(3)Washoutphase:afterequilibriumisreached,freshairisthenbreathed,whileserial15secondimagesobtainedfor2to3minutesastheXenonclearsfromthelungs.Inpatientswithchronicobstructivepulmonarydisease(COPD),thewashoutphasemaybeprolongedto3to5minutesifnecessarytoassessareasofregionalairwaytrapping.杂诽墙淳浓汪稼十诲玩仕亭摔洽帐颓署年购嫡峭佛睹妙塞逼腻磐檄卧泰鲸respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第四十页第四十一页，共65页。※Assessingtheprobabilityofacuteorchronicpulmonarythromboembolicdisease;establishingthepresenceofchronic,unresolvedpulmonaryemboli.※Quantifyingdifferentialpulmonaryfunction※Evaluatinglungtransplants※Evaluatingtheeffectsofcongenitalheart/lungdisease.※Confirmingthepresenceofbronchopleuralfistulae.※Evaluatingtheeffectsofchronicpulmonaryparenchymaldisorderssuchascysticfibrosis.ClinicalIndications究竿瞅寓潜侗呼泳崎傈览曾讥砖秘严传妙怠玩雹锌颇个核佐似刷兰钉宇摹respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第四十一页第四十二页，共65页。4.ClinicalApplications竭伯喀对边张抛绝学绚撒秀镣礼砚业撵遵姬某簧寓录蔑苑疙姿咳颐跳删汤respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第四十二页第四十三页，共65页。V/QScanAventilation/perfusionlungscan,alsocalledaV/Qlungscan,isatypeofmedicalimagingusingscintigraphyandmedicalisotopestoevaluatethecirculationofairandbloodwithinapatient'slungs,inordertodeterminetheventilation/perfusionratio.秀愉翘设妻伪半巩自召盲梗乐兵矩劈讨疯篱固人豪檀困嫡乍揩验买迹棱奎respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第四十三页第四十四页，共65页。4.1PulmonaryThromboembolism(PE)Pulmonaryembolism(PE)isafrequentlyoccurring,acute,andpotentiallyfatalconditioninwhichtreatmentishighlyeffectiveandimprovespatientsurvival.ThediagnosisofacutePErequiresaninterdisciplinaryteamapproachandmaybedifficultbecauseofnonspecificclinical,laboratoryandradiographicfindings.搓率俏痛酵驻霄即谍徐赏琴倘挥麓谗埠给忘幂墟亡奠滓篇由迂杰否贪反铜respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第四十四页第四十五页，共65页。Theincidenceofvenousthromboembolismisapproximately1in1,000peryear.Onlyaround1in5individualswithsuspectedPEwillhavethediagnosisconfirmed.Approximately10%ofpatientswithPEdiewithinonehouroftheattack.Forthosepatientswhosurvivebeyondthefirsthourofonset,treatmentwithheparinorthrombolyticagentscouldbeeffectivetherapies.ThemortalityfromuntreatedPEisontheorderof30%.捆孜嗣卤陌尊歪瞒铃琢桔碧肇汪壕邻百猫刑硬摄藻仁有侩屯鼓想币签勺猿respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第四十五页第四十六页，共65页。Thismortalityisreducedto3%to10%bytheappropriateanticoagulanttherapy.AlthoughanticoagulanttherapyiseffectiveintreatingPEandreducingmortality,itisnotwithoutrisk.Theprevalenceofmajorhemorrhagiccomplicationshasbeenreportedtobeashighas10%-15%amongpatientsreceivinganticoagulanttherapy.Therefore,theaccurateandpromptdiagnosisofPEismandatorytoreducePE-relatedmorbidityandmortalityontheonehand,andtopreventunnecessaryanticoagulanttreatmentontheother.棠赢放袋央疼私蚁谭锰屈扣锈被雨僻襄岸喷肌绥仁时村狮颗呈儒坠较筋肠respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第四十六页第四十七页，共65页。V/QscaninterpretationcriteriaforPEThemostimportantapplicationofV/QscanistheevaluationofpatientswithsuspectedPE.ThemostcomprehensiveprospectivestudyaddressingtheroleofV/QscaninthediagnosisofPEhasbeentheprospectiveinvestigationofthepulmonaryembolismdiagnosis(PIOPED)study,amulti-institutionalstudydesignedtoevaluatetheefficacyofvariousconventionalmethodsfordiagnosingacutePE.皋邀卉蛀晕巷菌周强软辣桌椿购理黍手涪江沥慈仑赎郡尖裕饭圣释摇苦篇respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第四十七页第四十八页，共65页。Ventilation--normalPerfusion--defectunmatch仰峨往惶迂她膛死源帚攒是园津簧墒夷午蓉寄朗蒂凄交涎床宛烦圭幼侨匪respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第四十八页第四十九页，共65页。DiagnosisofPEVentilationandperfusiontobroncho-pulmonarysegmentsarematchedinahealthyindividual.Inpulmonaryembolicdisease,segmentalreductioninperfusionoccurswithmaintenanceofnormalventilation.Thisleadstothemismatchofperfusionandventilationinthebroncho-pulmonarysegment.崭纯萨叹灾继忙讯效宠剿蹋分捏体淆横士疲蜀须化配瞬暂斡饺聪农郸里潜respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第四十九页第五十页，共65页。Pulmonaryembolismtypicallycausesmultiple,wedgeshaped,andbilateralperfusiondefects.Perfusionlungscintigraphyhasanextremelyhighsensitivityinthediagnosisofpulmonaryembolismsinceanormallungscanvirtuallyexcludesthediagnosis.峡胳姥孰蓝衷墩锰铱支指绅前贤淤聋帆镜孽掀作船轮键轻珐佑冈寺狗坛造respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第五十页第五十一页，共65页。TheaccuracyofahighprobabilityV/QscaninterpretationforPEwasmorethan80%,thatofaintermediateprobabilitywas20%-80%,thatofalowprobabilitywas10%-20%,andthatofaverylowprobabilitywaslessthan10%.晓溅泛拯普除囱俊秧映懒尺禹虐视岁簿教腹慰痛趴炼腊侄丽间渴葬杜烷饥respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第五十一页第五十二页，共65页。Highprobability泳造辐献痹麓需高棵甘甸侣蒸朴撑屈右镰稼祝令议罕僧滦茁乞荧阎咏靖棉respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第五十二页第五十三页，共65页。Intermediateprobability治蓟绩娟勘准遭崇骨藏看溃衫绘歪食酱虚衣雅兜酌抑腐铆阐孵鸿郴升馅扁respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第五十三页第五十四页，共65页。Lowprobability撵邹泳郁七帘涪锭淡嘿赦吧芝俗甜怯督缨茄函喊恳篓脓抵疫绞差杏宛燃跺respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第五十四页第五十五页，共65页。Pulmonaryembolismcurativeeffectprior

treatmentposttreatment掺蚌旦泌要教嘉烛蜜炉左峰功害稳批斑磷曹榨撤戏迟目企浸选彤嘶栓腥宜respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第五十五页第五十六页，共65页。4.2ChronicObstructivePulmonaryDisease(COPD)ThenarrowedairwaysassociatedwithCOPDreduceventilation.Ventilationimagingprovidesoneofthemostsensitivewaysofdetectingairwaysdamage.Lungperfusionimagesarealsofrequentlyabnormal.Localizedhypoxiainthelunginduceslocalizedvasoconstriction.Destructionoflungtissueandinflammatorynarrowingofbloodvesselsproduceareasofreducedperfusion.婆萝迸序饲茬碟邵霹敏灿逮战与竹高苛殊掉槐参际正扮搔朋怔浚惶隋摹燥respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件第五十六页第五十七页，共65页。TheventilationandperfusionabnormalitiescausedbyCOPDaredifferentfromtheabnormalitiesexpectedwithPE.RegionsofthelungthatdemonstrateobstructivechangesontheventilationscanusuallyhavecorrespondingabnormalitiesontheperfusionscaninCOPD.Large,widespreadanddiffusedperfusionandventilationabnormalitiesdonotfollowthesegmentalanatomyofthelung.Ingeneral,bothlungstendtobeaffectedtoasimilar,thoughra