CT冠状动脉造影与腺苷负荷心肌灌注显像诊断冠心病的对比研究

Relationship between computed tomography coronary angiography and adenosine stress myocardial perfusion imaging for the assessment of coronary artery disease

目的以传统冠状动脉造影（CAG）结果为参照，对比CT冠状动脉造影（CTCA）与腺苷负荷心肌灌注显像（MPI）诊断冠心病的准确性，并探讨两者间的关系。方法56例怀疑或诊断为冠心病的患者，3周内接受CTCA、腺苷负荷MPI及CAG检查，CTCA将患者分为无冠脉病变组、非阻塞性冠脉病变组（冠脉狭窄〈70％）及阻塞性冠脉病变组（冠脉狭窄≥70％），分别对比评价两种无创检测冠心病方法的特点。结果CTCA发现5例无冠状动脉粥样硬化，19例非阻塞性冠脉病变，32例阻塞性冠脉病变。腺苷负荷MP!提示26例未见异常，18例显示不可逆性的心肌灌注缺损，29例可逆性心肌灌注缺损。以CAG为对照，CTCA检测冠心病的敏感性为100％，特异性为55．6％，阳性预测值为92．2％，阴性预测值为100％；而腺苷负荷MPI检测冠脉病变〉170％的病变，敏感性为78．6％，特异性为71．4％，阳性预测值为73．3％，阴性预测值为76．9％。结论CTCA与腺苷负荷MPI分别从动脉粥样硬化的形态学与心肌缺血的功能学方面给冠心病的诊断提供了较准确的信息，两者相辅相成，是无创的、全面的诊断冠心病的有力工具。

Objective To compare the accuracy of computed tomography coronary angiography （CTCA） and adenosine stress myocardial perfusion imaging in the diagnosis of coronary artery disease （CAD） and discuss their relationship. Methods Fifty-six patients, suspected or diagnosed as CAD, were performed with CTCA, MPI and coronary angiography （CAG） within 3 weeks. They were divided into 3 groups： no CAD, no obstructive CAD （coronary artery stenosis 〈 70% ） and obstructive CAD （coronary artery stenosis ≥70% ）. Results 5 patients were diagnosed as no CAD. 19 patients were diagnosed as no obstructive CAD and 32 patients were diagnosed as obstructive CAD by CTCA. while adenosine stress MPI Suggested 26 patients normal. 18 patients had IPD and 29 patients had RPD. The sensibility, specificity, positive predictive value （PPV） and negative predictive value （NPV） of CTCA were 100% , 55.6% , 92.2% and 100% versus 78.6% , 71.4% , 73.3% and 76. 9% respectively for adenosine stress MPI. Conclusion CTCA and adenosine stress MPI provide different and complementary information on CAD, anatomical versus functional. As compared with CAG, CTCA has a high accuracy of detecting CAD.