双嘧达莫负荷^201Tl心肌灌注显像及肺/心比值测定在心肌缺血诊断中的价值

The Value of Dipyridamole Stress Myocardial Perfusion Imaging with ^(201)Tl in Myocardial Ischemia of Negative Coronary Angiography

目的:探讨双嘧达莫负荷201Tl心肌灌注显像结合肺/心比值(LHR)测定技术在评价冠脉造影阴性心绞痛患者心肌缺血中的诊断价值。材料和方法:46例有典型心绞痛症状、同期冠状动脉造影检查均未发现异常的患者,和25例正常者接受双嘧达莫负荷试验下早期与延迟相201Tl心肌灌注显像,进行心肌节段缺血计分并测定LHR值。患者同期接受心电图超声心动图检查以供对照。结果:46例心绞痛患者心肌缺血指数均呈异常,提示存在心肌缺血,25例正常者心肌灌注显像均正常;两组LHR值间存在显著差异(P<0.01)。心肌缺血定位(前、侧、间、后下壁)、单或多节段缺血、左室心肌肥厚与否对LHR值无影响(P>0.05);高血压组与无高血压组在LHR值上存在显著差异(P<0.01)。结论:双嘧达莫负荷试验下201Tl心肌灌注显像结合LHR测定,兼具灌注显像的定性、定位优势和LHR测定对血流动力学、左室功能的定量优势,在冠脉造影阴性的心肌缺血评价中具有重要临床价值。

Purpose： Pharmacological stress of dipyridamole was used in ^201Tl myocardial perfusion imaging in order to enhance the detection rate of myocardial ischemia along with lung/heart ratio measurement. Materials and Methods ： 46 patients with typical angina peetoris but negative coronary angiography and 25 healthy persons underwent dipyridamole stress myocardial perfusion imaging at early（5 - 10min） and late（3 -4h） phase after injection of ^201Tl. Ischemia was diagnosed if the difference on ischemic score over 1 between the 2 phases. Lung/heart ratio measurement was performed using ROI at both phases. Results： All of 46 patients had obvious lower score at late phase after pharmacological stress than at early phase, indicating myocardial ischemia. No ischemic score could be detected in 25 healthy persons. The LHR ratio of patients group was significantly higher than that of healthy group （P 〈 0.01 ）. The site, size of the ischemia, and hypertrophy of myocardium in our group of patients did not influence LHR ratio （P 〉 0.05 ）. The LHR ratio in patients of hypertension was significantly higher than that of normal blood pressure（ P 〈 0.01 ）. Conclusion： Dipyridamole stress combined with lung/heart ratio measurement improved the detection rate and the diagnostic confidence in ^201 Tl myocardial perfusion imaging of ischemia.