心脏磁共振与核医学负荷心肌灌注显像探测冠心病心肌缺血的对比研究  

Stress perfusion cardiac magnetic resonance imaging for detection of coronary artery disease: comparison with single-photon emission computed tomography: a prospective study

作　　者：董薇[1] 贺毅[2] 李全[3] 范占明[2] 王占宏[2] 赵轶轲[2] 

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所核医学科,100029 [2]首都医科大学附属北京安贞医院医学影像科,100029 [3]首都医科大学附属北京安贞医院心内科,100029

出　　处：《心肺血管病杂志》2016年第5期373-377,共5页Journal of Cardiovascular and Pulmonary Diseases

基　　金：北京市科学技术委员会基金(Z141100000214010);基础临床科研合作基金课题(15JL58)

摘　　要：目的:对比心脏磁共振成像(CMR)与核医学单光子计算机断层扫描(SPECT)负荷心肌灌注显像探测冠心病心肌缺血的诊断效能。方法:前瞻性入选51例疑似或确诊冠心病患者,所有患者在冠状动脉造影(CAG)检查之前或之后4周内进行了CMR和SPECT负荷心肌灌注显像,三种检查之间无任何再血管化治疗。以CAG作为参考标准,将CMR与SPECT分析结果进行比较,计算其诊断效能。结果:基于患者个体分析,CMR和SPECT负荷心肌灌注成像检测狭窄50%以上冠状动脉的敏感性及特异性分别为:90%和75%;74%和75%。CMR的诊断效能0.879,与SPECT 0.818相似(P=0.3377);基于血管分析,CMR和SPECT负荷心肌灌注成像检测狭窄50%以上冠状动脉的敏感性及特异性分别为:78%和83%;75%和86%。CMR的诊断效能0.827,略好于SPECT 0.767(P=0.1284)。其中基于分支血管进行分析,CMR探测左前降支(LAD)分支血管病变的诊断效能0.849好于SPECT 0.688(P=0.0141)。CMR探测左旋支及右冠状动脉分支血管的诊断效能与SPECT相似,两者间差异无统计学意义。结论:CMR与SPECT负荷心肌灌注成像均能有效检测冠心病心肌缺血,基于患者个体分析,CMR与SPECT相比敏感性高,特异性相同;基于血管分析,CMR的敏感性和特异性均好于SPECT,尤其对于LAD分支血管病变。Objective： To assess the diagnosis performance of stress CMR for evaluating CAD compared with SPECT. Methods： 51 symptomatic consecutive patients were prospectively enrolled with known and suspected CAD underwent sequential CMR, SPECT and CAG. we compared the diagnostic performance of stress CMR and SPECT for detecting CAD on a per-patient and per-vessel basis. For diagnostic performance assessment the AUC was calculated respectively using CAG as the reference standard. Results： First, on a patient- based model, CMR for detection of CAD had sensitivity of 90.0% and specificity of 75.0% versus the sensitivity of 74% and specificity of 75% of SPECT. The diagnostic performance of CMR 0. 879 was similar to SPECT 0. 818 （P =0. 3377 ,n =51 ）. On a vessel-based analysis, CMR had a sensitivity of 78.0% and specificity of 83.0% versus a sensitivity of 75.0% and specificity of 86. 0% of SPECT. The AUC of CMR 0. 827 was slightly superior to SPECT 0. 767 （P =0. 1284, n =51 ）, for LAD vessel, The AUC of CMR 0. 849 was superior to SPECT 0. 688 （P = 0. 0141, n = 51 ）. Conclusions： Stress cardiac MRI and SPECT are both useful and valuable in CAD patients. Compared with SPECT, stress CMR had better sensitivity and similar specificity based on patient analysis, and better sensitivity and specificity based on vessel analysis, especially for LAD vessel.

关 键 词：心脏磁共振成像 单光子计算机断层扫描 冠状动脉血管造影 受试者工作特征曲线 

分 类 号：R54[医药卫生—心血管疾病]