^(99m)Tc-MIBI门电路SPECT对冠心病的诊断和心肌存活性评价的作用

Gated tectechnetium-99m-sestamibi SPECT for detection and evaluation of coronary artery disease

为进一步评价99m锝-甲氧基异睛（99mTC－MIBI）门电路和非门电路单光子发射断层显像（SPECT）对冠心病的诊断价值及硝酸甘油介入诊断试验在心肌存活状态评价中的作用，对40例进行运动心肌灌注断层显象，并与冠状动脉（冠脉）造影比较。结果32例冠脉造影显示冠脉有意义狭窄。门电路断层显象对冠心病诊断总的敏感和特异性分别为93．8％和87．5％；非门电路断层显象分别为84．4％和87．5％，两相比较，无显著性差异（P＞0．05）。对冠脉病变支数诊断敏感性门电路方法优于非门电路方法（分别为73．8％和62．3％，P＜0．05）．特异性均为96．6％。20例进行含服硝酸甘油后静态心肌灌注断层显象，16例心肌梗死病人中有3例为部分可逆性心肌灌注缺损，4例慢性心肌缺血病人，全部有可逆性心肌灌注。表明硝酸甘油介人诊断试验有助于心肌灌注异常可逆性的评估；99mTc－MIBI门电路SPECT和硝酸甘油介入诊断试验是有效的对冠心病无创性诊断和心肌存活状态评价方法。

To test the hypothesis that gated SPECT perfusion imaging with Tc-99m-sestamibiis superior to ungated SPECT imaging in detection and evaluation of coronary artery disease (CAD),40 patients were underwent exercise gated SPECT and coronary angiography(32 of them had significant coronary stenosis ). Compared with coronary angiography, the overall sensitivity for the detection of CAD was 94% (32/33 ) and 84% (24/34) with gated SPECT and ungated SPECT respectively. Overall specificity for CAD was 84% and 88% by geted and ungated SPECT,respectively. The sensitivety for individual diseased arteries was 75% by gated SPECT and 62% by ungated SPECT (P<0. 05 ) and specificity for normal coronary arteries was 95% by gated and ungated SPECT. In a group of 20 patients with resting myocardial perfusion defects, 3 of 16 patients with previous Mlshowed partial reversal of the perfusion defect and all 4 patients with chronic ischemia showed reversal on nirtoglycerin resting gated SPECT. Thus gated SPECTwith Th-99m-sestamibi allowed accurate assessment of regional myocardial perfusion and more accurate detection of significant coronary stenosis compared to ungated SPECT. Nitrites adminitration might beable to detect reversible ischemia myocardium with Tc-99m-sestamibi imaging.