电子束CT检出冠状动脉钙化及其与心肌灌注显像的对比研究

A comparative study of electron beam CT and myocardial perfusion imaging in assessment of coronary artery disease

目的比较电子束ＣＴ（ＥＢＣＴ）检查冠状动脉钙化（ＣＡＣ）及核素心肌灌注显像（ＭＰＩ）评价冠心病（ＣＨＤ）的价值。材料与方法本组５０例均为临床疑诊或确诊为ＣＨＤ患者。所有患者均行ＥＢＣＴ、ＭＰＩ及冠状动脉造影。结果４０例患者共８４支血管冠状动脉造影证实有明显的冠状动脉病变（ＣＡＤ）（狭窄＞５０％），其中１４例为单支病变，８例为双支病变，１８例为三支病变，另有１０例冠状动脉造影正常。ＥＢＣＴ预测ＣＡＤ的敏感性、特异性及准确性为８３％、８０％及８２％，ＭＰＩ预测ＣＡＤ的敏感性、特异性及准确性分别为８５％、８０％及８４％，ＥＢＣＴ与ＭＰＩ的结果间无显著性差异（Ｐ＞０．０５）。ＣＡＣ血管供血区出现心肌缺血者达６５％。结论ＣＡＣ是预测ＣＡＤ的有价值指标。在有症状的人群中ＥＢＣＴ检出ＣＡＣ预测ＣＡＤ的敏感性、特异性及准确性与ＭＰＩ相似。有症状人群中检出ＣＡＣ患者多有心肌缺血或梗死，因此为早期诊断冠心病，应对无症状人群进行筛选。

Purpose To compare coronary artery calcification(CAC) detected by electron beam CT(EBCT) with myocardial perfusion imaging(MPI) performed by SPECT in assessment of coronary artery disease(CAD). Materials and methods Fifty consecutive patients with suspected or documented CAD were studied. All of them underwent EBCT, 99m Tc MIBI SPECT (stress rest) as well as coronary angiography. Results Fourty patients with 84 involved vessels were angiographically proved to have CAD(>50% stenosis)(14 patients with single, 8 with double and 18 with triple vessels disease) while 10 patients had normal coronary angiography. The sensitivity, specificity and accuracy of CAC on EBCT for predicting CAD was 83%, 80% and 82% while that of MPI was 85%, 80% and 84% respectively. Ischemia was shown in 65% of myocardial segments supplied by the calcified coronary arteries. Conclusion Detection of CAC with EBCT is a valuable method in assessment of CAD. In symptomatic population, the majority of patients with CAC had myocardial ischemia that was proved by MPI, therefore screening for CAC should be carried out in asymptomatic population in order to detect CAD at early stage.