腺苷负荷心肌灌注显像与双源CT冠状动脉造影诊断冠心病

Adenosine stress myocardial perfusion imaging and dual-source computed tomography for detecting coronary heart disease

目的探讨腺苷(ADE)负荷门控心肌灌注显像(G-MPI)与双源CT冠状动脉造影(DSCTCA)诊断冠状动脉病(CAD)的价值。方法选择CAD可能性为低、中、高度的患者共53例,采用两日法行静息、腺苷负荷锝标记甲氧基异丁基异腈(99mTc-MIBI)G-MPI及DSCTCA,并于4周内进行CAG。采用美国心脏病协会17节段5分制(0～4分)目测半定量方法对MPI结果进行分析,静息与负荷评分的差值>1为可逆性缺血。DSCTCA结果采用目测直径法判断冠状动脉狭窄程度,分为:正常、狭窄<50%及狭窄程度≥50%。以CAG结果为"金标准",狭窄程度≥50%时定义为CAD,比较MPI和DSCTCA对CAD的诊断价值及两者之间的关系。结果 G-MPI和DSCTCA对CAD的诊断敏感度、特异度及准确率分别为94.44%(34/36)、52.94%(9/17)、81.13%(43/53)及88.89%(32/36)、88.24%(15/17)、88.68%(47/53)。两种检查方法差异有统计学意义(χ2=9.28,P=0.005)。结论 G-MPI和DSCTCA诊断CAD均有较高价值,联合应用可提供功能及解剖两方面的信息,提高对CAD的诊断效能。

Objective To explore the value of adenosine（ADE） stress gated myocardial perfusion imaging（G-MPI） and dual-source CT coronary angiography（DSCTCA） in diagnosis of coronary artery disease（CAD）.Methods Fifty-three patients with low,medium and high probability of CAD underwent resting（REST）,ADE stress G-MPI and DSCTCA,then they underwent CAG within 4 weeks.MPI results were analyzed using the American Heart Association 17 segment 5-point scale（0—4 points） visual semi-quantitative method,and the resting and stress rating of the difference 1 were identified as reversible defect.Coronary stenosis were determined using international common law of DSCTCA visual diameter and were divided into normal and stenosis 50% or ≥50%.Taking CAG results as gold standards and stenosis ≥50% defined as CAD,diagnostic value of MPI and DSCTCA was compared.Results According to CAG results,the sensitivity,specificity and accuracy of G-MPI and DSCTCA in diagnosis of CAD was 94.44%（34/36）,52.94%（9/17）,81.13%（43/53） and 88.89%（32/36）,88.24%（15/17）,88.68%（47/53）,respectively（χ2=9.28,P=0.005）.Conclusion G-MPI and DSCTCA both have high value in diagnosis of CAD,combination of these two methods can improve the diagnostic utility of CAD through obtaining both functional and anatomical information.