核素心肌灌注显像对扩张型心肌病和缺血性心肌病的鉴别诊断价值

Diagnostic value of dilated cardiomyopathy and ischemic cardiomyopathy with ^(99m)Tc-MIBI myopathy perfusion imaging

目的探讨99mTc-MIBI心肌灌注显像(MPI)对扩张型心肌病(DCM)和缺血性心肌病(ICM)的鉴别诊断价值。方法55例确诊心肌病患者,根据病史、超声心动图检查,分成扩张型心肌病组(25例)和缺血性心肌病组(30例)。同时完成核素99mTc-MIBI心肌灌注显像与冠脉造影(CAG)检查。观察99mTc-MIBI在心肌的分布情况,分析病损心肌、病变血管之间的关系。结果①所有55例患者,心肌灌注显像都99mTc-MIBI放射性分布异常:DCM组节段性灌注完全缺损2例(8%),均匀减低14例(56%),不均匀减低3例(12%),花斑样改变6例(24%);ICM组节段性灌注完全缺损29例(96.67%),均匀减低1例(3.33%)。冠脉造影检查:DCM组仅1例(4%)发现冠脉异常,但狭窄程度<50%,ICM组30例(100%)都有不同程度的冠脉狭窄(≥50%);②以核素99mTc-MIBI在心肌不均匀减低和/或花斑样分布为标准,MPI诊断DCM的敏感性为96.15%,特异性为95.6%,以核素99mTc-MIBI在心肌呈节段性灌注完全缺损分布为标准,MPI诊断ICM的敏感性是96.7%,特异性是92%。结论核素99mTc-MIBI心肌灌注显像在心肌的这种特征性分布,对扩张型心肌病和缺血性心肌病的诊断和鉴别诊断有较高的临床价值,与冠脉造影有很好的相关性,值得在临床推广应用。

Objective To evaluate the diagnostic value of dilated cardiomyopathy （DCM） and ischemic cardiomyopathy （ICM） with ^99mTc-MIBI myocardial perfusion imaging（MPI）. Methods 55 patients of myocardial diseases were divided into the group of DCM （25 cases）and ICM（30 cases）. All the patients were performed MPI and coronary angiography（CAG）. To analysis the distribution of ^99mTc-MIBI in myocardium,to detective the relation of pathylogical myocardium and pathylogical blood vessel. Results ① 55 eases had abnormal ^99mTc-MIBI imaging. In DCM group;②cases（8% ）had complete defect segment, 14 cases （56%） had even reduction of the radicoactivity,3 cases （ 12% ） had abnormal reduction of the radioactivity, 6 cases （24%） had patchy patter;In ICM group ：29 cases （96. 67% ） had complete defect segment,1 case （3.33%） had even reduction of the radioactivity, no abnormaland patchy pattern was found. CAG：In DCM group：1 case（4% ） had coronary stenosis （stenosis〈50%） ;In ICM group ： All case （ 100% ） had comary stenosis （ stenosis ≥ 50% ） ; ②The diagnostic senstiveness of DCM by even reduction radioactivity was 96. 15% ,the specificity was 95.6% ;the diagnostic senstiveness of ICM by complete defect segment was 96. 7% , the specificity was 92%. Conclusion ^99mTc-MIBI myocardial perfusion imaging was used to differentiate patients with DCM from ICM, It is well correlated with the results of coronary angiography , It is spreaded in clinical.