核素心肌灌注显像与64层螺旋CT诊断冠状动脉疾病的对比研究  

Comparative study of myocardial perfusion imaging and 64 multi-slice spiral CT for the diagnosis of coronary artery disease

作　　者：赵骏[1] 徐龙宝[1] 万仁明[1] 范光磊[1] 刘剑文[1] 黄曙新[1] 

机构地区：[1]南京医科大学附属常州第二人民医院核医学科,213000

出　　处：《中华核医学杂志》2010年第6期367-371,共5页Chinese Journal of Nuclear Medicine

摘　　要：目的 对比分析心肌灌注显像（MPI）与64层螺旋CT（MSCT）对冠状动脉疾病（CAD）的诊断价值.方法 对52例可疑和确诊CAD患者（疑诊43例,确诊9例）进行MPI检查,并均在1个月内行冠状动脉造影（CAG）和64层MSCT检查.MPI结果分析采用17节段5分制,获得运动负荷显像灌注总积分和静息显像灌注总积分,两者差值大于1为心肌缺血,判断为阳性.MSCT结果主要以冠状动脉或其主要分支中至少有1支血管管腔狭窄≥50%判定为阳性.以CAG结果为诊断CAD的＂金标准＂.采用SPSS 13.0软件,用Kappa值检验2种方法结果的一致性,两样本率的比较采用配对资料x2检验.结果 MPI和MSCT诊断CAD的灵敏度、特异性、阳性预测值、阴性预测值及准确性分别为86.7%（26/30）、77.3%（17/22）、83.9%（26/31）、81.0%（17/21）、82.7%（43/52）和83.3%（25/30）、86.4%（19/22）、89.3%（25/28）、79.2%（19/24）、84.6%（44/52）;MPI和MSCT对病变血管检出的灵敏度、特异性、阳性预测值、阴性预测值及准确性分别是74.5%（38/51）、81.0%（85/105）、65.5%（38/58）、86.7%（85/98）、78.8%（123/156）和90.2%（46/51）、88.6%（93/105）、79.3%（46/58）、94.9%（93/98）、89.1%（139/156）,2种方法诊断CAD和病变血管差异均无统计学意义（x2=0.44和0.21,P均＞0.05）.MSCT评价病变血管轻度、中度和高度狭窄的灵敏度分别为76.5%（13/17）,78.3%（18/23）和89.6%（43/48）.MPI和MSCT诊断CAD的效能相近,Kappa值为0.64（＜0.75）.25例2种方法均阳性患者,96.0%（24/25）确诊为CAD;18例均阴性的患者,83.3%（15/18）可排除CAD.结论 MPI和MSCT均为筛选、诊断CAD的重要无创检查手段,但信息互补,不可替换.Objective To compare the diagnostic value of myocardial perfusion imaging （MPI） and 64 multi-slice spiral CT （64-MSCT） for coronary artery disease （CAD）. Methods Fifty-two patients with suspected or known CAD were included in the study. Each patient underwent both stress and rest MPI,MSCT as well as conventional coronary angiography （CAG） within 1 month. The stress and rest MPI were scored by a 5-grade criteria （0 ～ 4） based on 17 coronary artery segments. The difference between summed stress and rest scores 〉 1 was defined as myocardial ischemia. Stenosis in one main vessel or one main branch of the main vessel ≥50% was defined as myocardial ischemia by MSCT. CAG was used as the reference for comparison. Statistical analysis was performed using SPSS 13. 0 software. Kappa value was used to test the accordance of MPI and MSCT results. X2 test was used to evaluate the difference between MPI and MSCT results. Results The patient-based sensitivity, specificity, positive and negative predictive values and accuracy of MPI and MSCT for the diagnosis of CAD were 86.7% （26/30）, 77.3% （ 17/22）,83.9% （26/31）, 81.0% （ 17/21）, 82.7% （43/52） and 83.3% （ 25/30）, 86.4% （ 19/22）, 89.3%（ 25/28）, 79.2% （ 19/24）, 84.6% （44/52）, respectively. The vessel-based sensitivity, specificity, positive and negative predictive values and accuracy of MPI and MSCT were 74.5% （38/51）, 81.0% （85/105 ）, 65.5% （38/58）, 86.7% （ 85/98）, 78.8% （ 123/156 ） and 90.2% （46/51 ）, 88.6% （ 93/105 ）,79.3 % （46/58）, 94.9% （93/98）, 89.1% （ 139/156）, respectively. There was no statistically significant difference between MPI and MSCT for either patient or lesion-based diagnosis （X2 =0.44, 0.21, both P 〉0.05 ）. 96.0% （24/25） patients with both abnormal MPI and MSCT positive were valified by CAG while 83.3% （15/18） patients with both MPI and MSCT negative were excluded by CAG. Conclusions Both MPI and MSCT are reliable diagnostic modalities for CA

关 键 词：冠状动脉疾病 体层摄影术 发射型计算机 单光子 体层摄影术 X线计算机 MIBI 

分 类 号：R686[医药卫生—骨科学]