运动^(99)Tc^m-MIBI心肌显像左室暂时性扩大诊断冠状动脉病变的价值

Diagnostic value of dilatation of the left ventricular cavity on exercise ^(99)Tc^m-MIBI imaging for coronary artery disease

目的 探讨定量分析运动99Tcm 甲氧基异丁基异腈 (MIBI)心肌显像左室暂时性扩大诊断冠状动脉 (简称冠脉 ) 3支病变的价值。方法 76例拟诊冠心病患者 ,平均年龄 (6 1± 8 3)岁。间隔1个月内完成运动 静息99Tcm MIBI心肌断层显像和冠脉造影检查。根据心肌短轴断层影像直径方向剖面曲线 2个峰值点间的距离计算左心腔面积 (LVD) ,以运动 /静息LVD比值 (LVDR)作为判断左心腔暂时性扩大的指标。结果 冠脉造影正常组、冠脉 1支病变、2支病变和 3支病变组LVDR平均值分别为 1 0 1± 0 0 5、1 0 2± 0 0 5、1 0 5± 0 0 4和 1 13± 0 0 6。 76例拟诊冠心病患者中左室暂时性扩大者 2 1例 ,其中 ,有冠脉 3支病变者 19例 (90 % )。LVDR值诊断冠脉 3支病变的灵敏度和特异性分别为 82 %和 94% ,常规分析方法分别为 5 0 %和 91%。其灵敏度显著高于常规分析方法 (χ2 =4 96 ,P <0 0 5 ) ,特异性差异无显著性 (χ2 =1 31,P >0 0 5 ) ,2种分析方法结合 ,灵敏度进一步提高 ,而特异性无显著下降。结论 定量分析运动99Tcm MIBI心肌显像左心腔暂时性扩大可提高其诊断冠脉 3支病变的灵敏度 ,不降低其特异性 ,LVDR值是诊断冠脉 3支病变的 1个新的有用指标。

Objective To investigate the diagnostic value of dilatation of the left ventricular cavity on exercise 99 Tc m MIBI imaging for triple vessel disease Methods Exercise and rest myocardial perfusion imaging were performed on 76 patients with known angiograms The exercise/rest ratio of the left ventricular dimension (LVD) from the 99 Tc m MIBI imaging was defined as the left ventricular dilatation ratio (LVDR) Results 21 of 76 patients showed an abnormal LVDR, and 19 of the 21 patients (90%) had triple vessel disease By routine analysis method, the sensitivity and specificity for diagnosing triple vessel disease was 50% and 91%, respectively, whereas LVDR had a sensitivity of 82% and a specificity of 94% When LVDR was used in combination with the routine analysis method, sensitivity increased to 91% without a significant loss of specificity Conclusions Quantitatively analysis of the dilatation of the left ventricular cavity on exercise 99 Tc m MIBI imaging could increase the sensitivity for diagnosing triple vessel disease and provide complementary information to exercise 99 Tc m MIBI imaging