心肌灌注显像结合冠状动脉CT血管造影在冠心病诊治中的应用价值  

Myocardial perfusion imaging combined with computed tomography coronary angiography in the diagnosis and treatment of coronary heart disease

作　　者：刘姝[1,2] 刘艳阳[3] 王雪梅[4] 张国建[4] 

机构地区：[1]辽河油田总医院循环内科,辽宁省盘锦市124010 [2]内蒙古医科大学 [3]内蒙古医科大学附属医院心内科 [4]内蒙古医科大学附属医院核医学科

出　　处：《疑难病杂志》2014年第8期778-782,786,F0003,共7页Chinese Journal of Difficult and Complicated Cases

基　　金：内蒙古科技厅应用技术与开发研究项目(No.09sfpet)

摘　　要：目的探讨心肌灌注显像(MPI)结合冠状动脉CT血管造影(CTA)对冠心病诊断及准确定位"罪犯"血管的价值。方法收集2012年2月—2013年12月住院的冠心病患者33例,男25例,女8例,年龄35~75(55.2±20.2)岁,均行^(13)N-NH_3PET腺苷负荷/静息MPI及冠状动脉CTA检查,1个月内完成冠状动脉造影(CAG),分别对MPI、CTA及CAG结果进行分析,以CAG结果为金标准,分析冠状动脉CTA、MPI及MPI联合冠状动脉CTA的诊断价值。结果(1)冠状动脉CTA诊断冠心病的灵敏度为90.0%(36/40)、特异度为95.0%(302/318)、阳性预测值为69.2%(36/52)、阴性预测值为98.7%(302/306)。(2)MPI诊断冠心病的灵敏度为90.9%(20/22)、特异度为90.9%(10/11)、阳性预测值为95.2%(20/21)、阴性预测值为83.3%(10/12)。(3)MPI联合冠状动脉CTA诊断冠心病的灵敏度为95.5%(20/21)、特异度为100%(11/11)、阳性预测值为100%(21/21)、阴性预测值为91.7%(11/12)。结论 MPI结合冠状动脉CTA可减少单纯MPI或CTA造成的"假阳性"和"假阴性",为冠心病的诊治提供更高准确性,尤其是提高了对"罪犯血管"的检出率。Objective To investigate myocardial perfusion imaging （MPI） combined with coronary CT angiography （CTA） in diagnosis of “culprit” coronary artery. Methods From 2012 February-2013 December, hospitalized patients with coronary heart disease （33 cases） were enrolled, male of 25 cases, female of 8 cases, age from 35 to 75 years old （55.2 ±20.2 ） , they were underwent13 N-NH3 PET adenosine / resting MPI and coronary artery CTA examination, within 1 months of coronary arteriography （CAG）, respectively. The MPI, CTA and CAG were analyzed; using CAG as golden standard, the di- agnostic value of coronary CTA, MPI and MPI combined coronary artery CTA were analyzed. Results （ 1 ） The sensitivity of CTA in diagnosis of coronary heart disease was 90.0% （36/40）, the specificity was 95.0% （302/318）, the positive predic- tive value was 69.2% （36/52）, the negative predictive value was 98.7% （302/306）. （2） The sensitivity of MPI in diagno- sis of coronary heart disease was 90.9% （20/22）, the specificity was 90.9% （10/11）, the positive predictive value was 95.2% （20/21）, the negative predictive value was 83.3% （10/12）. （3） The sensitivity of MPI combined with CTA in diag- nosis of coronary heart disease was 95.5% （20/21）, the specificity was I00% （ 11/11 ）, the positive predictive value was 100% （21/21）, the negative predictive value was 91.7% （11/12）. Conclusion MPI combined with coronary CTA can de- crease the “false positive” and “false negative” results caused by MPI or CTA alone, provides higher accuracy for the diagno- sis and treatment of coronary heart disease, especially to improve the detection rate of “culprit” vessel.

关 键 词：冠心病 冠状动脉造影 腺苷负荷心肌灌注显像 CT血管造影 

分 类 号：R541.4[医药卫生—心血管疾病]