心肌代谢-灌注半定量评分在冠状动脉旁路移植术中的应用  

The value of semi-ouantitative myocardial metabolic-perfusion scores in coronary artery bypasses grafting

作　　者：张佳胤[1] 李彪[1] 孔烨[2] 周健[2] 章剑锋[2] 张立颖[1] 王超[1] 朱承谟[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院核医学科,200025 [2]上海交通大学医学院附属瑞金医院心胸外科,200025

出　　处：《中华核医学杂志》2007年第1期19-22,共4页Chinese Journal of Nuclear Medicine

摘　　要：目的评估放射性核素心肌显像代谢-灌注半定量评分在冠状动脉旁路移植术(CABG)中的应用价值。方法选择21例多支冠状动脉病变的冠心病患者进行前瞻性研究。所有患者术前均进行^(99)Tc^m-甲氧基异丁基异腈(MIBI)门控心肌灌注显像(G-MPI)与^(18)F-脱氧葡萄糖(FDG)PET 心肌代谢显像,评估心肌缺血的范围、程度及心肌活力。检查后2周内行 CABG。所有患者术后第3个月随访行 G-MPI。结果 G-MPI 和 PET 图像的定性和半定量分析均根据美国核心脏病学会(ASNC)提出的阅片指南,分别计算每一心肌节段的静息灌注评分(RS)、代谢-灌注差值(DS)及静息灌注总分(SRS)和代谢-灌注总差值(SDS)。心肌节段的 DS<0分即认为该部位心肌存活,反之则认为心肌活力丧失。在共420个心肌节段中,G-MPI 共检出164个缺血节段,其中93个节段活力丧失,71个节段存活。根据术前 SDS 结果,将患者分为3组:A 组 SDS≥0分,5例;B 组-5分≤SDS<0分,8例;C 组 SDS<-5分,8例。随访 G-MPI 发现上述3组术后左室射血分数绝对值较术前分别提高-3.60%,3.38%和6.88%。结论心肌代谢-灌注半定量评分可准确评价患者 CABG 后疗效,并可预测术后左室功能恢复程度。Objective Coronary artery bypass grafting （CABG） is the preferred method of coronary revascularization in the coronary artery disease （CAD） patients with multi-vessel involvement. The study was aimed to evaluate the role of semi-quantitative assessment of myocardial viability scores using PET in CABG. Methods Twenty-one consecutive patients with multi-vessel CAD were recruited from the department of cardiac/thoracic surgery. All patients underwent gated myocardial perfusion imaging （G-MPI） and ^18F-fluorodeoxyglucose （FDG） myocardial PET imaging to assess the extent and severity of ischemia as well as the myocardial viability. The images were interpreted according to the semi-quantitative method issued by American Society of Nuclear Cardiology （ASNC） imaging guidelines using a 20-segment nomenclature. Summed rest score （SRS） and summed difference score （SDS） were calculated accordingly, All patients were scheduled for CABG within 2 weeks after the radionuclide myocardial imaging. The follow-up G-MPI was performed in all patients in the 3rd month after the surgery. Results Out of the total 420 segments, 164 segments had abnormal myocardial perfusion by preoperative G-MPI. Among them, 93 segments were identified as non-viable （with difference score≥0） and the remaining 71 viable （with difference score 〈0）. Based on their SDS, the patients were divided into 3 groups： group A （SDS≥0, n =5）, group B （ -5≤SDS 〈0, n = 8） and group C （ SDS 〈 - 5, n = 8）. The mean change of global left ventricular ejection fraction （LVEF） after CABG in the three groups were - 3.6%, 3.38% and 6.88% respectively. Conclusion Assessment of myocardial viability by PET imaging is valuable in predicting whether the CAD patients may benefit from CABG.

关 键 词：冠状动脉疾病 冠状动脉分流术 体层摄影术 发射型计算机 单光子 体层摄影术 发射型计算机 MIBI 脱氧葡萄糖 

分 类 号：R654.2[医药卫生—外科学] R817.4[医药卫生—临床医学]