CZT SPECT心肌血流定量测定对冠心病的诊断效能和增益价值  

Diagnostic efficiency and incremental value of myocardial blood flow quantification by CZT SPECT for patients with coronary artery disease

作　　者：庞泽堃 汪娇[1] 陈越[1] 褚洪鑫 张梦岩 李剑明[1] Pang Zekun;Wang Jiao;Chen Yue;Chu Hongxin;Zhang Mengyan;Li Jianming(Clinical School of Cardiovascular Disease,Tianjin Medical University,Department of Nuclear Medicine,TEDA International Cardiovascular Hospital,Tianjin 300457,China)

机构地区：[1]天津医科大学心血管病临床学院,泰达国际心血管病医院核医学科,天津300457

出　　处：《中华心血管病杂志》2022年第5期494-500,共7页Chinese Journal of Cardiology

摘　　要：目的探讨与传统心肌灌注显像(MPI)半定量参数相比,碲锌镉(CZT)单光子发射计算机断层成像(SPECT)动态MPI测定的心肌定量血流参数对冠心病的诊断效能及其增益价值。方法本研究为回顾性、横断面研究。选取2018年10月至2020年12月期间于泰达国际心血管病医院成功完成CZT SPECT动态MPI定量血流测定的可疑或确诊冠心病患者。收集患者的基本临床资料,CZT SPECT测定MPI半定量参数(负荷积分、静息积分和差值积分)及心肌定量血流参数[静息心肌血流量(rMBF)、负荷心肌血流量(sMBF)和心肌血流储备(MFR)]。根据冠状动脉血管造影结果,分别以任意一支冠状动脉狭窄≥50%或≥75%两种情况作为判断狭窄的阳性参考标准,将患者分为狭窄组和对照组。比较两组间心肌定量血流参数及半定量参数的差异,并采用受试者工作特征(ROC)曲线比较两种类型参数对冠心病的诊断效能。结果共纳入98例患者,年龄(62.1±8.7)岁,其中男性66例(67%)。在患者水平,以冠状动脉狭窄程度≥50%为阳性标准时,狭窄组(58例)左心室sMBF(LV-sMBF)[(1.36±0.45)ml·min^(-1)·g^(-1)比(2.09±0.64)ml·min^(-1)·g^(-1)]和左心室MFR(LV-MFR)[(1.45±0.43)比(2.17±0.54)]均低于对照组(40例);狭窄组负荷总积分和差值总积分均高于对照组(P均<0.05)。以冠状动脉狭窄程度≥75%为阳性标准时,狭窄组(38例)LV-sMBF[(1.19±0.34)ml·min^(-1)·g^(-1)比(1.94±0.63)ml·min^(-1)·g^(-1)]和LV-MFR[(1.34±0.35)比(2.00±0.58)]均低于对照组(60例);狭窄组各半定量参数均高于对照组(P均<0.05)。在血管水平,以冠状动脉狭窄程度≥50%为阳性标准时,狭窄组(122支)sMBF[(1.26±0.49)ml·min^(-1)·g^(-1)比(1.95±0.70)ml·min^(-1)·g^(-1)]和MFR[(1.35±0.46)比(2.05±0.65)]均低于对照组;狭窄组负荷积分和差值积分均高于对照组(P均<0.05)。以冠状动脉狭窄程度≥75%为阳性标准时,狭窄组(74支)sMBF[(1.12±0.41)ml·min^(-1)·g^(-1)比(1.84�Objective To investigate the diagnostic efficiency and incremental value of quantitative myocardial blood flow measurements by Cadmium-Zine-Telluride(CZT)single photon emission computed tomography(SPECT)dynamic myocardial perfusion imaging(MPI)in patients with coronary artery disease(CAD)compared with traditional semi-quantitative measurements by MPI.Methods This is a retrospective,cross-sectional study.We retrospectively analyzed clinical data of patients with suspected or known CAD,who underwent the dynamic MPI quantitative blood flow measurement of CZT SPECT in TEDA International Cardiovascular Hospital from October 2018 to December 2020.Clinical data,semi-quantitative parameters(stress score(SS),rest score(RS)and different score(DS))and myocardial quantitative blood flow parameters(rest myocardial blood flow(rMBF),stress myocardial blood flow(sMBF)and myocardial flow reserve(MFR))were analyzed.According to the results of coronary angiography,patients were divided into the stenosis group and the control group with coronary artery stenosis≥50% or≥75% as the diagnosis criteria.The differences of quantitative and semi-quantitative parameters between the two groups were compared,and the diagnostic efficacy was compared by receiver operating characteristic(ROC)curve.Results A total of 98 patients with a mean age of(62.1±8.7)years were included in the study,including 66 males(67%).At the patient level,with the positive standard of coronary artery stenosis≥50%,the left ventricle(LV)stress MBF(LV-sMBF)((1.36±0.45)ml·min^(-1)·g^(-1))and LV-MFR(1.45±0.43)of the stenosis group were lower than the LV-sMBF((2.09±0.64)ml·min^(-1)·g^(-1))and LV-MFR(2.17±0.54)of control group;summed SS and summed DS were higher than control group(all P<0.05).With the positive standard of coronary artery stenosis≥75%,the LV-sMBF((1.19±0.34)ml·min^(-1)·g^(-1))and LV-MFR(1.34±0.35)of stenosis group were lower than the LV-sMBF((1.94±0.63)ml·min^(-1)·g^(-1))and MFR(2.00±0.58)of control group;all semi-quantitative parameter

关 键 词：冠状动脉疾病 碲锌镉 单光子发射型断层成像 心肌定量血流测定 诊断效能 

分 类 号：R541.4[医药卫生—心血管疾病]