IQ·SPECT与常规SPECT心肌灌注显像诊断症状恶化稳定性冠心病的价值  

Value of IQ·SPECT versus conventional SPECT myocardial perfusion imaging to the diagnosis of stable coronary heart disease with worsening symptoms

作　　者：杜彪[1] 韩星敏[1] 刘艳[1] 王瑞华[1] 王旭[1] 刘保平[1] DU Biao;HAN Xing-min;LIU Yan;WANG Rui-hua;WANG Xu;LIU Bao-ping(Department of Nuclear Medicine,the First Af filiated Hospital of Zhengzhou University,Henan Medical Key Laboratory of Molecular Imaging,Zhengzhou,Henan 450000,China)

机构地区：[1]郑州大学第一附属医院核医学科河南省分子影像医学重点实验室,河南郑州450000

出　　处：《中华实用诊断与治疗杂志》2022年第11期1091-1095,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省医学适宜技术推广项目(SYJS2020088)。

摘　　要：目的 应用配备SMARTZOOM准直器的IQ·SPECT、配备低能高分辨准直器的常规SPECT对拟诊症状恶化的稳定性冠心病(stable coronary artery disease, SCAD)患者行负荷/静息核素心肌灌注显像(myocardial perfusion imaging, MPI),记录左心室半定量灌注参数变化,探讨二者对SCAD患者心肌缺血的诊断价值。方法 拟诊症状恶化的SCAD患者97例,分别应用IQ·SPECT、常规SPECT行2日法负荷/静息MPI,采用半定量视觉分析计算总负荷评分(summed stress score, SSS)、总静息评分(summed rest score, SRS)、总差异评分(summed difference score, SDS),通过Cedars定量灌注评分软件分析获得左心室半定量灌注参数包括负荷总灌注缺损(stress-total perfusion deficit, S-TPD)、静息总灌注缺损(rest-total perfusion deficit, R-TPD)、缺血总灌注缺损(ischemic total perfusion deficit, iTPD)评分。以冠状动脉造影结果为金标准,比较2种显像方法SSS、SRS差异;Spearman相关法分析2种显像方法SSS、SRS与S-TPD、R-TPD评分的相关性;绘制ROC曲线,计算各参数对SCAD患者心肌缺血的诊断效能。结果 IQ·SPECT显像SSS[9(5,19)分]、SRS[7(4,17)分]、S-TPD[11(6,20)分]、R-TPD[8(4,17)分]评分均高于常规SPECT显像[7(4,15)、5(3,11)、10(6,19)、6(3,14)分](P<0.05),iTPD评分[2(2,3)分]低于常规SPECT显像[4(2,7)分](P<0.05),SDS与常规SPECT显像比较差异无统计学意义(P>0.05)。IQ·SPECT显像时,SSS与S-TPD评分呈正相关(r=0.528,P<0.001),SRS与R-TPD评分呈正相关(r=0.573,P<0.001);常规SPECT显像时,SSS与S-TPD评分呈正相关(r=0.540,P<0.001),SRS与R-TPD评分呈正相关(r=0.596,P<0.001)。IQ·SPECT显像时SSS、SRS、SDS分别以8.5、7.5、2.5分为最佳截断值,常规SPECT显像时SSS、SRS分别以5.5、4.5分为最佳截断值,诊断SCAD患者心肌缺血的AUC均>0.644;其中IQ·SPECT显像时SSS诊断心肌缺血的灵敏度(70.0%)、准确率(68.1%)最高,SDS诊断心肌缺血的特异度最高(81.1%)。结论 与常规SPECT比较,拟诊症�Objective To perform stress/rest myocardial perfusion imaging (MPI)IQ·SPECT with SMARTZOOM collimator and conventional SPECT system with low-energy high-resolution collimator(LEHR)in patients with suspected stable coronary artery disease (SCAD)with worsening symptoms,to record the left ventricular semi-quantitative perfusion parameters and to investigate their diagnostic values.Methods Ninety-seven suspected SCAD patients with worsening symptoms were treated with two-day stress/rest MPI IQ·SPECT and conventional SPECT acquisition methods,respectively.Semi-quantitative visual analysis was used to calculate the summed stress score(SSS),summed rest score(SRS),and summed difference score (SDS).The left ventricular semi-quantitative perfusion parameters as stress-total perfusion deficit(S-TPD),rest-total perfusion deficit(R-TPD)and ischemic total perfusion deficit(iTPD)were obtained by Cedars quantitative perfusion score automatic analysis software.Taking coronary angiography results as the gold standard,the differences of SSS and SRS between two imaging methods were compared.Spearman correlation method was used to analyze the correlations of SSS and SRS with S-TPD and R-TPD scores.ROC curves were drawn and the diagnostic efficiency of each parameter on myocardial ischemia was calculated.Results The scores of SSS,SRS,S-TPD and R-TPD were higher by IQ·SPECT imaging[9(5,19),7(4,17),11(6,20),8(4,17)]than those by conventional SPECT imaging[7(4,15),5(3,11),10(6,19),6(3,14)](P<0.05),the iTPD score was lower by IQ·SPECT imaging[2(2,3)]than that by conventional SPECT imaging[4(2,7)](P<0.05),and the SDS showed no significant difference between IQ·SPECT and conventional SPECT imaging(P>0.05).SSS was positively correlated with S-TPD score(r=0.528,P<0.001)and SRS was positively correlated with R-TPD score(r=0.573,P<0.001)by IQ·SPECT imaging;SSS was positively correlated with S-TPD score(r=0.540,P<0.001),and SRS was positively correlated with R-TPD score(r=0.596,P<0.001)by conventional SPECT imaging.When the optimal cut-off

关 键 词：稳定性冠心病 症状恶化 IQ·SPECT 常规SPECT 心肌灌注显像 

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