冠状动脉成像与核素心肌显像评价功能相关性冠状动脉病变的对比研究

Comparison of coronary angiography with myocardial perfusion imaging in assessment of functionally relevant coronary artery lesion

目的 以单光子发射计算机断层（SPECT）心肌灌注显像（MPI）为参考标准,采用双源CT冠状动脉成像（DSCTCA）评价功能相关性冠状动脉病变（FRCAL）的准确性.方法 59例临床疑诊冠心病的患者,行DSCTCA、99Tcm-甲氧异丁基异腈（MIBI）SPECT心肌灌注显像及冠状动脉造影（CCA）检查,将DSCTCA冠状动脉直径狭窄≥50%定义为狭窄,并与MPI表现进行对比分析,DSCTCA评价以CCA为标准.结果 （1）DSCTCA和CCA间的一致性好（按患者计算Kappa=0.93,按血管计算Kappa=0.88）.（2）DSCTCA发现34例60支86个节段的冠状动脉有狭窄.（3）MPI检出25例患者的45处心肌灌注缺损区,其中可逆缺损19处、部分可逆缺损21处、恒定缺损5处.（4）以MPI为参考标准,DSCTCA检出65.0%（39/60）的病变冠状动脉为FRCAL;DSCTCA检出心肌灌注缺损的敏感度、特异度、准确度、阳性预测值、阴性预测值,以患者计算分别是92.0%、67.6%、78.0%、67.6%、92.0%,以血管计算分别是86.7%、89.0%、88.6%、65.0%、96.6%.（5）ROC分析发现DSCTCA与CCA在预测FRCAL时有相似的诊断价值,其曲线下面积（AUC）分别是：0.80、0.82.结论 DSCTCA可以间接评价FRCAL,DSCTCA结果为阴性时,有助于排除FRCAL,而异常的DSCTCA结果需结合MPI综合评价.

Objective To evaluate the accuracy of dual-source CT coronary angiography （DSCTCA） for the depiction of functionally relevant coronary artery lesion （ FRCAL） , by using myocardial perfusion imaging （MPI） with single photon emission computed tomography（SPECT）. Methods DSCTCA,99Tcm-MIBI SPECT myocardial perfusion imaging （MPI） and conventional coronary angiography （CCA） were performed in 59 patients with clinical suspected CAD . Coronary artery diameter narrowing of 50% or greater at DSCTCA was defined as stenosis and was compared with MPI findings. CCA was served as a reference standard for DSCTCA. Results （1） Agreement between DSCTCA and CCA was good （kapaa = 0.93 for patient-based analysis, Kappa = 0. 88 for vessel-based analysis） . （2） DSCTCA revealed stenoses in 86 segments corresponding to 60 arteries in 34 patients. （3） MPI revealed 19 reversible,21 partially reversible, and 5 fixed defects in 25 patients. （4） About 65.0% （39/60） of all the narrowed coronary arteries were determined to be FRCAL Sensitivity, specificity, accuracy, positive predictive values and negative predictive values, respectively, of DSCTCA in the detection of all MPI defects were 92.0%, 67.6%, 78.0%, 67. 6% and 92. 0% on a per-patient basis and 86. 7% , 89. 0% , 88. 6% , 65. 0% and 96. 6% on a perartery basis. （5） ROC analysis showed that predictive value of DSCTCA in FRCAL was similar with those of CCA （AUCs = 0. 80, 0. 82）. Conclusions DSCTCA can evaluate FRCAL indirectly. When DSCTCA results are negative,it can help ruled out patients with FRCAL The positive DSCTCA results should combin MPI in predictor of myocardial ischemia.