腺苷负荷心肌灌注显像在冠心病诊断中的应用

Application of adenosine stress myocardial perfusion tomographic imaging in diagnosis of coronary artery diseases

目的:评价腺苷负荷心肌灌注显像试验对冠心病的诊断价值。方法:60例住院患者均行腺苷负荷心肌灌注显像和冠状动脉造影(CAG),腺苷以0.14mg/(kg.min)的速度外周静脉输入,第3分钟时,静脉注射放射性核素99mTc-MIBI740MBq,1.5h后进行心肌断层显像,若异常,次日行静息心肌显像,分析腺苷负荷试验心肌核素显像对于冠心病诊断的敏感性、特异性及其特点。结果:CAG阳性42例中,心肌核素显像阳性37例(敏感性88%)。18例CAG无明显狭窄,其中13例心肌核素显像阴性(特异性为72%)。前降支病变36例,心肌核素前壁区域低灌注20例,回旋支病变22例,侧壁区域低灌注14例,右冠脉病变28例,下壁区域低灌注27例,右冠脉病变较前降支或回旋支病变的心肌核素显像阳性率高(P<0.05)。在应用过程中,腺苷未出现明显不良反应。结论:腺苷负荷试验心肌核素灌注显像对于冠心病诊断的敏感性、特异性较高,对诊断冠心病具有重要意义。

AIM： To analyze the sensitivity and specificity of adenosine stress myocardial perfusion tomographic imaging in the diagnosis of coronary artery diseases （CAD）. METHODS： Adenosine was infused IV at a rate of 0. 14 mg/（kg·min） and 3 rain after adenosine infusion, 740 MBq of 99Tc-MIBI was injected IV. Single photon emission computer tomography （SPECT） myocardial imaging acquisition was obtained 1.5 h after adenosine infusion. With an abnormal result, rest myocardial perfusion imaging would be performed on the next day. Coronary angiography was performed in all patients within 1 week of myocardial imaging. RESULTS ： Sixty cases （57 ± 11 years old） , 35 men, 25 women were included in this study. In the 50 cases of CAD patients confirmed by coronary angiography, 42 patients had positive adenosine stress myocardial perfusion tomographic imaging. Thirteen of the 18 cases without CAD had negative adenosine stress myocardial perfusion tomographic imaging. Sensitivity and specificity of adenosine myocardial perfusion tomographic imaging in the diagnosis of CAD were 88% and 72% , respectively. Sensitivity of adenosine myocardial perfusion tomographic imaging in the diagnosis of coronary stenosis in left anterior descending, left circumflex and right coronary artery were 20/36, 14/22 and 27/28, respectively. No severe adverse side effect was observed during adenosine stress test. CONCLUSION： Adenosine stress myocardial perfusion imaging has relatively high sensitivity and specificity in the diagnosis of CAD and plays an important role in the diagnosis of CHD.