锝-氮-氮欧乙替心肌灌注显像对冠心病的诊断评价

Diagnostic value of ^(99m)Tc-N-NOET myocardial perfusion imaging during exercise for coronary artery disease

目的评价锝-氮-氮欧乙替(^(99m)Tc-N-NOET)心肌灌注显像检测冠心病的价值。方法对42例临床疑诊冠心病患者,行^(99m)Tc-N-NOET 运动负荷和再分布心肌灌注显像,所有患者行冠状动脉造影检查。结果在42例患者中,26例冠状动脉造影显示有冠状动脉狭窄病变,其中单支病变10例,二支病变7例,三支病变9例。^(99m)Tc-N-NOET 心肌显像检出心肌缺血或心肌梗死21例,未检出异常5例;16例冠状动脉造影正常患者,^(99m)Tc-N-NOET 心肌显像正常14例,异常2例。^(99m)Tc-N-NOET 心肌灌注显像诊断冠心病的敏感性为81%、特异性为88%、阳性预测值91%,阴性预测值74%,预测准确性为83%。诊断单支、二支和三支冠状动脉病变的敏感性分别为60%(6/10)、86%(6/7)、100%(9/9)。42例均无干扰心肌分辨的肺、肝重度摄取增高者。15 min 运动负荷显像肺脏摄取高,尤以冠状动脉狭窄患者增高明显。结论 ^(99m)Tc-N-NOET 心肌灌注显像检测冠心病敏感性、特异性较高,早期显像肺摄取增加与有意义的冠状动脉病变有关。

Objective To assess the value of ^99mTc-N-NOET （^99m Tc-N-ethoxy-N-ethyl dithiocarbamato nitrito ） myocardial perfusion SPECT for the diagnosis of coronary artery disease. Methods A total of 42 patients [mean age （54 ±9） years,35 men] with suspected chest pain were included in this study. 740 MBq of 9^9mTc-N-NOET was injected intravenously during bicycle exercise when the heart rate attained reached more than 85% of the expected maximum, or in cases of angina pectoris, severe arrhythmias and ischemic ST segment changes. ^99mTc-N-NOET 740 MBq, SPECT myocardial imaging acquisitions were obtained at 15 minutes and 2 hours after ^99mTc-N-NOET injection. Coronary angiography was performed in all patients. Results Coronary artery stenosis was detected in 26 patients and normal coronary angiography was shown in 16 patients. ^99mTc-N-NOET myocardial perfusion imaging was abnormal in twenty-one patients out of the 26 patients with significant coronary artery stenosis （sensitivity, 81% ） ;14 out of 16 patients with normal angiography had a normal myocardial perfusion imaging （specificity, 88% ）. The positive predictive value, negative predictive value and predictive accuracy of ^99mTc-N-NOET myocardial perfusion imaging for detection of CAD was 91% , 74% and 83% , respectively. The sensitivity of the imaging for detecting single vessel, double vessels and triple vessels disease were 60% （6/10）, 86% （6/7） and 100% （9/9） ,respectively. There was mild ^99mTc-N-NOET lung uptake in patients with coronary artery stenosis 15 minutes post ^99mTc-N-NOET injection. Conclusion SPECT myocardial perfusion imaging with ^99mTc-N-NOET supplied an important diagnostic tool for detecting coronary artery disease. Lung uptake with stress ^99mTc-N-NOET might be related to coronary artery disease.