融合影像技术评价冠状动脉病变功能改变及临床价值

Effect of Hybrid Imaging Technique of SPECT/CT on Functional Assessment in Coronary Artery Lesions

目的:探讨同机心肌灌注显像和冠状动脉计算机断层摄影术(CT)成像融合影像技术评价冠状动脉病变的功能改变,及其在冠心病诊断中的临床价值。方法:30例可疑或确诊冠心病患者行同机负荷心肌灌注(myocardial perfusion imaging,MPI)和冠状动脉CT成像(coronary tomography coronary angiography,CTCA),负荷心肌灌注和CTCA按常规方法完成,利用融合软件整合冠状动脉解剖与心肌灌注功能影像,所有患者1个月内完成冠状动脉造影。负荷心肌灌注、CTCA和冠状动脉造影图像分别由2位以上有经验的核医学科和影像科、心内科和影像科医师判读;负荷-静息心肌灌注显示心肌"可逆性"缺损判为心肌缺血,显示心肌"不可逆性"缺损判为心肌梗死;冠状动脉造影及CTCA冠状动脉管腔狭窄≥50%定义为有临床意义。结果:基于冠状动脉血管及相应心肌供血区的对应关系,以冠状动脉造影或冠状动脉造影联合负荷心肌灌注作为标准对照,CTCA诊断冠心病的敏感性89.29%(25/28),特异性88.71%(55/62),阳性预测值78.13%(25/32),阴性预测值94.83%(55/58),准确性88.89%(80/90)。MPI诊断冠心病的敏感性70.73%(29/41),特异性81.63%(40/49),阳性预测值76.32(29/38),阴性预测值76.92%(40/52),准确性76.67%(69/90)。MPI/CTCA融合显像诊断冠心病,评价冠状动脉病变功能改变的敏感性96.43%(27/28),特异性90.32%(56/62),阳性预测值81.82%(27/33),阴性预测值98.25%(56/57),准确性92.22%(83/90)。结论:心肌灌注显像和CTCA融合影像技术评价冠状动脉病变功能改变,与单一影像技术比较,可明显提高冠心病及冠状动脉病变功能异常的诊断效能,并同时提供冠状动脉解剖及心肌血供功能信息,对冠状动脉疾病诊疗有较高的临床价值。

Objective：To explore the effect of hybrid imaging technique of SPECT/CT on functional assessment of coronary lesions and its clinical value of diagnosis and treatment in coronary artery disease （CAD）. Methods ：A total of 30 patients who suffered from CAD or suspected for CAD were examined by contrast enhanced CT coro- nary angiography（CTCA） and adenosine stress/rest myocardial perfusion imaging（MPI） by SPECT/CT scanning. Combined coronary anatomy and perfusion imaging information were obtained by using fusion technique. All patients underwent coronary angiograms （GAG）within one month of the SPECT/CT examination. Two or more experienced nuclear medicine physicians and radiologists reviewed the image of MPI and CTCA blinded to the results of CAG, and two or more cardiologists reviewed the CAG image blinded to the results of MPI and CTCA. Reversible defect by stress/rest MPI was defined as ischemia, irreversible defect by stress/rest MPI was defined as myocardial infarction. Coronary artery stenosis ≥50% by the criterion of CAG/CATA was defined Results：The sensitivity,specificity, positive and negative predictive value in assessment of CAD by CTCA were 89.29% , 88.71%, 78.13 %, 94. 83 % respectively ; by MPI Were 70. 73 %, 81.63 %, 76. 32%, 76. 92% respectively; and by MPI/CTCA fusion imaging were 96.43% ,90. 32% ,81.82% ,98.25% respectively. Conclusion ： Combination of SPECT-MPI and CTCA were superior to either CATA or SPECT-MPI alone in assessment of coronary lesions. It provided the complementary information of coronary anatomy with the pathophysiology of the lesion and it was important in CAD diagnosis and treatment in clinical practice.