^(99)Tc^m氮欧乙替心肌核素显像的冠心病诊断分析

Diagnosis of coronary artery disease with 99Tcm-N-NOET myocardial perfusion imaging

目的评价再分布型显像剂99Tcm氮欧乙替(N-NOET)心肌核素显像(MPI)对于冠心病诊断的敏感性和特异性。方法住院病人同时行冠状动脉造影和99TcmN-NOET腺苷负荷试验MPI。腺苷总量为840μg／kg,6 min匀速静脉泵入,腺苷泵入3 min时静脉推注99TcmN-NOET剂量740 MBq(20 mCi),15 min后行负荷心肌显像,2 h后进行再分布心肌显像。结果入选53例,年龄35- 79(56±10)岁,男36例,女17例。冠状动脉有一支血管直径狭窄超过50％即冠状动脉明显狭窄组31例,MPI均为阳性;冠状动脉无明显狭窄组22例,MPI阳性6例,MPI阴性16例。99TcmN-NOET腺苷负荷试验MPI对于冠状动脉狭窄超过50％的敏感性为100％,特异性为73％,阳性预测值为84％,阴性预测值为100％。9例冠心病病人接受了再血管化处理,有6例病人的桥支血管或冠状动脉支架内有再狭窄,其中5例病人对应区域出现灌注不良;3例病人无明显冠状动脉支架内再狭窄,MPI均阴性。结论再分布型显像剂99TcmN-NOET MPI对于冠状动脉狭窄诊断的敏感性和特异性较高,且检查能在同一天内进行,有较好的临床应用价值。

Objective To evaluate the sensitivity and specificity of ^99Tc^m-N-NOET myocardial perfusion tomagraphie imaging （MPI） for the diagnosis of coronary artery disease （CAD）. Methods Coronary angiography and 99Tcm-N-NOET myocardial perfusion tomagraphic imaging were performed in the patients hospitalized in the Department of Cardiology, Peking Union Medical College Hospital, from June to December 2005 with known or suspected diagnosis of CAD. Adenosine was infused intravenously at a rate of 140 μg · kg^-1min^-1 for 6 minutes. At the third minute of adenosine infusion, 740 MBq （20 mCi） ^99Tc^m-N- NOET was injected intravenously. MPI was obtained 15 minutes after the ^99Tc^m-N-NOET infusion. If the result was abnormal, rest myocardial perfusion imaging would be performed 2 hours later. Coronary angiography was performed in all patients within one week after the myocardial perfusion imaging. Results Myocardial perfusion imaging was performed in 53 cases, 36 males and 17 females, aged 56 ± 10, who underwent coronary angiography, among which 31 had ≥50% stenosis of coronary artery and 23 had normal coronary artery. All of the patients with stenosis of coronary artery had positive ^99Tc^m-N-NOET adenosine stress myocardial perfusion imaging. Nineteen out of the 29 cases without stenosis of coronary artery had negative adenosine myocardial perfusion imaging. The sensitivity and specificity of ^99Tc^m-N-NOET adenosine myocardial perfusion imaging were 100% and 73% respectively in the detection of stenosis of coronary arteries. Seven cases got percutaneous coronary intervention and 2 got coronary artery bypass graft. Six of the 9 patients undergoing revascularization had stenosis of stents or grafts, 5 of which had positive myocardial perfusion imaging. 3 cases hadn＇t restenosis and their results of myocardial perfusion imaging were negative. Conclusion ^99 Tc^m-N-NOET myocardial perfusion imaging is a useful non-interventional method for detecting coronary artery stenosis.