运动-静息门控心肌断层显像中冠心病预后参数与灌注缺损关系的初步探讨  

Relationship between Prognostic Parameters for CAD and Gated SPECT Myocardial Perfusion Imaging

作　　者：郭烽[1] 李思进[2] 赵文锐[1] 梁英魁[1] 武志芳[2] 

机构地区：[1]海军总医院核医学科,北京100048 [2]山西医科大学附属第一医院核医学科,太原030001

出　　处：《中西医结合心脑血管病杂志》2014年第11期1334-1336,共3页Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease

摘　　要：目的分析左室暂时性扩大(TID)及肺摄取增加相关指标与灌注缺损的关系。方法回顾性分析2004年1月—2009年12月在山西医科大学第一医院核医学科行99mTc-MIBI运动-静息门控单光子计算机断层扫描心肌灌注显像的可疑冠心病患者共170例,男103例,女67例,年龄51.8岁±12.7岁。根据显像结果,以17节段靶心图模型对运动心肌灌注显像图像进行评分,获取各个节段评分之和,即运动总积分(SSS)。左室功能参数及左室暂时性扩大比率(TID ratio)由ECToolbox软件自动处理获得。依据SSS结果将患者分为四组:G1组(SSS≤3,血流灌注正常)、G2组(4≤SSS≤8,血流灌注轻度异常)、G3组(9≤SSS≤13,血流灌注中度异常)及G4组(SSS≥14,血流灌注重度异常)。结果行冠状动脉造影的12例患者中,G1组中有4例;G2组中有1例;G3组中有2例;G4组中有5例。TID ratio、SVR(5)随SSS的增加而增高,在G4组中,二者均较G1组明显增高(分别为1.10±0.19与0.99±0.13,1.12±0.39与0.92±0.16,P<0.008);在G3组中,SIVR(5)亦较G1组明显增高.而TID ratio较G1组无统计学意义。随着SSS的增加运动LHR及静息LHR均逐渐升高,在G3组、G4组中二者均较G1组明显增高;运动LHR与静息LHR相比,在G3(0.32±0.08与0.31±0.04,P<0.05)及G4组(0.35±0.07与0.32±0.06,P<0.05)中有统计学意义。结论运动负荷中心腔一过性扩大及肺摄取增加均与心肌缺血及冠脉病变关系密切。SIVR(5)及运动LHR在检测心肌缺血方面较TID ratio及静息LHR更为灵敏,有一定的临床应用价值。Objective To analysis the relationship between transient ischemia dilation （TID）,increased lung uptake related indi- cators,and perfusion defects in Gated SPECT and prognosis of coronary artery disease（CAD）,explore its preliminary clinical appli- cation.Methods Stress and rest 99mTc MIBI Gated SPECT were performed in 170 patients with suspect coronary artery disease（67 female and 103 male patients were included）.Semiquantitative summed stress scores （SSS）were determined using a 17 seg- ment,5 point model,which was calculated by summing all regions where radial plot activity fell below the normal limits.The left cardi- ac function and transient ischemia dilation ratio （TID ratio）were processed automatically by the ECToolbox software.Lung/heart ra- tio （LHR）was calculated by left lung ROI average pixel counts/myocardium ROI average pixel counts.In addition,the stress in- duced volume ratio （5）[SIVR（5）]defined as stress to rest ratio,was calculated.All patients were divided into four groups ac- cording to the SSS：The G1 （SSS≤3）,G2 （4≤SSS≤8）,G3 （9≤SSS≤13）,and G4（SSS≥14）.Results 1.Twelve patients un- derwent angriscopy,4 patients were divided in G1,1 in G2,2 in G3,and 5 in G4.2.The TID ratio and SIVR（5）were getting higherwith the increasing of SSS.In G4,TID ratio and SIVR（5）were significantly greater than G1 （1.10±0.19 vs 0.99±0.13,1.12±0.39 vs0.92±0.16,P 〈0.008）.Comparing the TID ratio and SIVR（5）between G3 and G1,an obstructive difference was seen in SIVR（5）,but not in TID ratio.According with the increasing of SSS,sLHR and rLHR were grown too higher.especially in G4,the valuesof two were more higher than in GI,a significant different was also seen in sLHR between G3 and G1.Compared sLHR and rLHRwithin each group,we found that there were significantly difference in G3 and G4 （0.32±0.08 vs 0.31±0.04,0.35±0.07 vs 0.32±0.06,P 〈0.05）.Conclusion TID and increased lung uptake are closely related with myocardial ischemia and c

关 键 词：左室腔暂时性扩大 肺心比 心肌缺血 收缩末期容积 

分 类 号：R541.4[医药卫生—心血管疾病] R81[医药卫生—内科学]