冠状动脉造影与运动负荷心肌灌注显像诊断冠心病的对比分析  

Comparison of coronary angiography and stress myocardial perfusion imaging with ^(99m)Tc-MIBI SPECT in the diagnosis of coronary artery disease

作　　者：齐欣[1] 何青[1] 曾学寨[1] 孙福成[1] 许锋[1] 季福绥[1] 周颖[2] 屈婉莹[2] 

机构地区：[1]北京医院心内科,北京100730 [2]北京医院核医学科

出　　处：《临床心血管病杂志》2002年第12期646-648,共3页Journal of Clinical Cardiology

摘　　要：目的 :比较冠状动脉造影 (CAG)和运动负荷心肌灌注显像对诊断冠心病 (CHD)的作用。方法 :2 35例患者在 1个月内进行了CAG和运动负荷99mTc MIBI心肌灌注单光子发射计算机断层显像 (SPECT)检查。CAG在主要血管及分支病变狭窄≥ 5 0 %为阳性 ;心肌灌注检查将左室分为 16个节段 ,运动态和静息态相比较 ,存在放射性缺损或填充为阳性。结果 :2 35例中CHD170例 ,其他心脏病 4 3例 ,无器质性心脏病 2 2例。 170例CHD中 ,16 8例CAG阳性 ,16 2例运动SPECT阳性。 4 3例其他心脏病中 13例运动SPECT阳性 (30 .2 % )。 2 2例无器质性心脏病病例中 3例运动SPECT阳性 (13.6 % )。在CHD的诊断中 ,CAG的敏感性为 98.8% ;运动SPECT敏感性为95 .3% ,特异性为 86 .4 %。结论 :在临床工作中 ,CAG和运动SPECT均为诊断CHD的有效手段。由于后者的无创性 ,易于重复 ,是临床随访的较好方法。但在其他心脏病患者 ,运动SPECT阳性率可达 30 .2 % ;在无明显心脏疾病者可达 13.6 %。因此 。Objective:To compare the efficiency of coronary artery angiogram (CAG) with that of 99 m Tc MIBI stress myocardial SPECT in the diagnosis of coronary artery disease (CAD).Methods: Two hundred and thirty five patients performed both CAG and 99m Tc MIBI stress myocardial SPECT within one month. CAG positive was defined by ≥50% diameter stenosis in coronary arteries and/or main branches. In myocardial SPECT protocol, the left ventricular wall was divided into 16 segments, and the image was taken from both stress and resting 99m Tc MIBI myocardial SPECT. The presence of perfusion defect or reversibility filling indicated a positive result.Results: One handred seventy cases were diagnosed as CAD, 43 casesas other kinds of heart problem and 22 cases without organic heart disease. Among the 170 cases of CAD, 168 cases showed positive CAG and 162 cases showed positive SPECT. Among the 43 cases with other kinds of heart problem, 13 cases showed positive SPECT ( 30.2 %), Among the 22 cases without organic heart disease, 3 cases showed positive SPECT( 13.6 %). The results indicated that for the diagnosis of CAD, the sensitivity of CAG was 98.8 %, while the sensitivity and specificity of stress myocardial SPECT were 95.3 % and 86.4 % respectively.Conclusion: Both CAG and stress 99m Tc MIBI myocardial SPECT provide high diagnostic accuracy for CAD detection. The later is non invasive and easy to repeat, and it is more convenient for following up. However, the positive myocardial SPECT results may be as high as 30.2 % for other kinds of heart problems, and 13.6 % for those without organic heart disease. It is necessary to distinguish CAD cases from those showing false positive myocardial SPECT.

关 键 词：冠状动脉疾病 冠状血管造影术 放射性核素心室显像术 诊断 

分 类 号：R541.404[医药卫生—心血管疾病]