负荷动态CT心肌灌注成像对心肌缺血的诊断价值  

Evaluation of Stress Dynamic CT Myocardial Perfusion Imaging in Diagnosing Myocardial Ischemia

作　　者：王洁[1] 陈宏伟[1] 方向明[1] 钱萍艳[1] 

机构地区：[1]南京医科大学附属无锡市人民医院医学影像科,江苏省无锡市214023

出　　处：《临床放射学杂志》2015年第1期41-45,共5页Journal of Clinical Radiology

摘　　要：目的探讨128双源CT(DSCT)行负荷动态心肌灌注检查对心肌缺血的诊断价值。方法 30例临床疑似或已知冠心病患者行负荷动态CT心肌灌注(CT-MPI)检查,获取其心肌血流值。以SPECT为参考标准,评价CTMPI诊断心肌灌注缺损的敏感性、特异性、阳性预测值(PPV)、阴性预测值(NPV)、准确性及其与SPECT诊断的一致性。结果 30例患者成功完成检查,所有节段平均心肌血流量(MBF)值为(99.11±31.98)ml·100ml-1·min-1,非缺血区MBF值(117.61±29.82)ml·100ml-1·min-1与缺血区MBF值(80.60±22.15)ml·100ml-1·min-1有显著的统计学差异(t=15.764,P<0.001)。CT-MPI检查中19例26个血管支配区域出现CT-MPI的灌注缺损,以节段为基础,出现灌注缺损者为52段。SPECT-MPI检出心肌灌注异常13例16个血管区,共34个心肌节段。以SPECT为参照,以人为基础,CT-MPI检测心肌缺血的敏感性、特异性、PPV和NPV分别为92.31%(12/13)、58.82%(10/17)、63.16%(12/19)和90.91%(10/11),准确性为73.33%,两种检查方式结果的一致性Kappa=0.485(P<0.005);以血管区和节段为基础,CT-MPI检测心肌缺血的敏感性、特异性、PPV和NPV分别为93.75%(15/16)、85.14%(63/74)、57.69%(15/26)、98.44%(63/64)和94.12%(32/34)、95.80%(456/476)、61.54%(32/52)、99.56%(456/458),准确性分别为86.67%和95.69%。两种检查结果的一致性分别为Kappa=0.634和0.772(P均<0.001)。结论负荷动态CT-MPI可较好地检测出心肌灌注缺损,对心肌缺血情况进行评估。Objective To evaluate stress dynamic load myocardial perfusion imaging （MPI） using 128-row dual-source CT scanner in diagnosing myocardial ischemia. Methods Thirty patient with clinically-suspected or confirmed coronary artery disease were included in this study. Stress dynamic MPI with 128-row dual-source CT scanner was performed in all patients. The myocardial blood flow （MBF） value was determined. Taking SPECT-MPI as the reference standard, the sen- sitivity, specificity, positive predictive value （PPV） and negative predictive value （NPV） of CT-MPI in the diagnosis of myocardial peffusion defect were evaluated, and the consistency with the diagnosis of SPECT-MPI was analyzed. Results Technical success was achieved in all 30 cases. The mean MBF value of all segments was （99.11 ± 31.89 ） ml · 100ml^-1 · min^-1; the MBF values of non-ischemic area and ischemic area were （117.61 ± 29.82） ml · 100m1-1 · min^-1 and （80.60 ± 22. 15） ml · 100m1-1 · min^-1 respectively, the differences were statistically significant （t = 15. 764, P 〈 0. 001 ）. In 19 cases receiving CT-MPI examination, myocardial perfusion defect was observed in 26 vascular perfusion are- as; and segment-based peffusion defect was revealed in 52 segments. SPECT-MPI detected abnormal myocardial peffusion in 13 patients, including 16 abnormal vascular perfusion areas with 34 myocardial segments in total. Compared with SPECT-MPI, the sensitivity, specificity, PPV and NPV of CT-MPI in detecting myocardial ischemia were 92.31% （12/ 13 ）, 58.82% （ 10/17）, 63.16% （12/19） and 90.91% （ 10/11 ） respectively, the accuracy was 73.33%. The consis- tency between CT-MPI and SPECT-MPI was evaluated with Kappa analysis, and Kappa value was 0. 485 （ P 〈 0. 005 ）. Based on the vascular perfusion area and on the myocardial segment, the sensitivity, specificity, PPV and NPV of CT-MPI in detecting myocardial ischemia were 93.75% （15/16） . 85.14% （63/74） . 57.69% （15/26） . 98.44% （63/64） re-spect

关 键 词：负荷心肌灌注成像 双源CT 动态增强扫描 心肌缺血 

分 类 号：R541.4[医药卫生—心血管疾病] R816.2[医药卫生—内科学]