核素心肌灌注显像结合冠状动脉CT成像评价2型糖尿病功能相关冠状动脉病变的价值

Evaluation of Combining Computed Tomography Coronary Angiography with Nuclear Myocardial Perfusion Imaging on Functionally Relevant Coronary Artery Lesions in Type 2 Diabetes Mellitus

目的应用核素心肌灌注显像(MPI)结合冠状动脉CT成像(CTCA)评价2型糖尿病冠状动脉病变对心肌血供的影响,并与单一MPI或CTCA进行比较。资料与方法纳入120例怀疑或确诊的冠状动脉粥样硬化性心脏病患者,根据其病史分为糖尿病组(n=58)和非糖尿病组(n=62),所有患者均行常规腺苷负荷/静息MPI和CTCA,并均于1个月内行冠状动脉血管造影术(CAG)。以CAG、CAG联合MPI作为标准评价单一MPI、CTCA、MPI结合CTCA对"功能相关冠状动脉病变"的诊断效能。结果糖尿病组MPI结合CTCA评价2型糖尿病冠状动脉病变与心肌血供关系的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为93.58%、86.15%、90.80%、91.89%、88.89%。非糖尿病组MPI结合CTCA评价冠状动脉病变与心肌血供关系的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为93.10%、91.43%、92.47%、94.74%、88.89%,均高于单一MPI或CTCA的诊断效能。结论 MPI结合CTCA评价2型糖尿病冠状动脉病变对心肌血供的影响,其诊断"功能相关冠状动脉病变"的效能明显高于单一影像技术。

Purpose To explore the value of combining computed tomography coronary angiography（CTCA） and myocardial perfusion imaging（MPI） and compare with single MPI or CTCA on the diagnosis of coronary artery lesions in type 2 diabetes mellitus（DM）.Materials and Methods A total of 120 patients who were diagnosed as CAD or suspected as CAD were divided into DM group（n=58） and non-DM group（n = 62）.All the patients underwent MPI,CTCA and coronary angiography（CAG） within one month.The diagnostic value of single MPI,CTCA and MPI combined with CTCA was assessed and compared using CAG or CAG combined with MPI as a gold standard.Results For DM group,the sensitivity,specificity,accuracy,positive and negative predictive value of combined MPI and CTCA in diagnosis were 93.58%,86.15%,90.80%,91.89% and 88.89%,respectively.For non-DM group,the sensitivity,specificity,accuracy,positive and negative predictive value of combined MPI and CTCA in diagnosis were 93.10%,91.43%,92.47%,94.74% and 88.89%,respectively.Conclusion Combined CTCA and MPI provide improved diagnostic accuracy for the early diagnosis on functionally relevant coronary artery lesions in type 2 diabetes mellitus patients.