门控心肌SPECT显像评价运动试验后缺血患者与显像正常者心功能参数变化  

Evaluation on the change of cardiac function parameters between myocardial ischemia and myocardial nonischemia patients post stress test by using gated myocardial SPECT

作　　者：樊蓉 郑容 马谭源 李家俊 FAN Rong;ZHEN Rong;MA Tan-yuan

机构地区：[1]国家癌症中心中国医学科学院北京协和医学院肿瘤医院核医学科,北京100021 [2]清华大学第一附属医院核医学科,北京100016

出　　处：《中国医学装备》2018年第4期6-9,共4页China Medical Equipment

摘　　要：目的:应用门控心肌单光子发射计算机断层(SPECT)显像,评价运动试验后缺血患者与心肌显像正常者心功能参数变化情况。方法:选取临床疑似或确诊的195例冠心病患者,依照运动-静息显像灌注积分差值(SDS)评分情况,将其分为心肌缺血组(90例)与心肌显像正常组(105例),所有患者均行两日法^(99)Tc^m-甲氧基异丁基异腈(^(99)Tc^m-MIBI)静息和(或)运动负荷门控心肌SPECT显像,均采用改良的迭代法重建图像,用定量门控SPECT(QGS)软件测量负荷及静息状态心功能参数,包括左心室射血分数(LVEF)、左心室舒张末期容积(EDV)、收缩末期容积(ESV)以及高峰充盈率(PFR),并比较两组间的差异。心肌灌注显像结果进行17节段5分法评分。所有患者均在门控心肌显像前后2周内行心脏超声检查,比较门控心肌显像与心脏超声测得的LVEF值。结果:心肌显像正常组负荷与静息状态所测量心功能参数EDV、ESV、LVEF以及PFR相比,差异无统计学意义(t=0.33,t=1.8,t=-1.38,t=0.45;P>0.05);心肌缺血组负荷与静息状态所测量LVEF相比,差异有统计学意义(t=-2.87,P<0.05);而心肌缺血组负荷与静息状态所测量心功能参数EDV、ESV以及PFR相比,差异无统计学意义。在心肌缺血组中,共有60例患者负荷门控所测量LVEF值小于或等于静息门控所测值,差异有统计学差异(t=4.81,P<0.05);门控心肌SPECT显像所测LVEF值高于超声心动图所测值。结论:心肌显像正常患者运动负荷与静息状态心功能参数无差异;心肌缺血患者运动负荷试验后LVEF下降;心肌缺血患者是否有一过性心腔扩大与其缺血程度有关;心肌缺血组与显像正常组的运动负荷及静息状态PFR并无差异。Objective:The aim of this study was to compare the cardiac function parameters of ischemic and nonischemic patient post stress test by using gated myocardial SPECT.Methods:A total of 195 patients with suspected or confirmed coronary artery disease(CAD)were divided into myocardial ischemia group(n=90)and normal perfusion group(n=105),according to the stress-test myocardial perfusion imaging summed difference score(SDS).All patients were performed rest and stress gated 99Tcm-MIBI SPECT perfusion imaging,and all images were obtained using improved iteration reconstruction method.The stress-rest cardiac function parameters,including left ventricular ejection fraction(LVEF),the end-diastolic volume(EDV),end-systolic volume(ESV)and peak filling rate(PFR),were calculated by Quantitative Gated SPECT(QGS)software.These parameters between two groups were compared.The segment perfusion was analyzed using a 5-point scale.All patients were performed echocardiography within two weeks before or after SPECT imaging,and the LVEF of the two groups were measured.Results:For normal perfusion group,matched pairs of rest cardiac function parameters and stress parameters demonstrated no significant difference(t=0.33,t=1.8,t=-1.38,t=0.45,P>0.05).For myocardial ischemic group,the difference of LVEF between rest and after stress test was statistically significant(t=-2.87,P<0.05).But there were no significant difference in EDV,ESV and PFR(t=-0.02,t=1.85,t=-0.44,P>0.05).In the 60 patients of myocardial ischemic group,LVEF value of stress imaging was significantly lower than that of rest imaging(t=4.81,P<0.05),and LVEF of QGS software was higher than that of echocardiography.Conclusion:Cardiac function parameters demonstrated the difference between stress and rest imaging for normal myocardial perfusion is no statistically significant.LVEF of ischemic patients can decrease after stress test is performed.And the incidence of transient ischemic dilatation in ischemic patients were related to severity of ischemia;and the difference of PFR betwe

关 键 词：门控心肌单光子断层显像 运动负荷试验 左心室射血分数 收缩末期容积 舒张末期容积 高峰充盈率 心肌顿抑 一过性缺血性扩张 

分 类 号：R814.42[医药卫生—影像医学与核医学]