心肌灌注断层显像和冠状动脉造影结果差异的分析

Study on the Unconfomable Results between Myocardial Perfusion SPECT and Coroner Angiograply

目的：回顾性分析６０例病人冠状动脉造影（ＣＡＧ）和心肌灌注显像（ＭＰＩ）结果不一致的资料。方法：所有 ＭＰＩ检查用Ｔｏｓｈｉｂａ ＧＣＡ－７１００Ａ／Ｄ型 ＳＰＥＣＴ仪完成。以ＣＡＧ结果示冠状动脉狭窄≥５０％为有临床意义的冠状动脉狭窄。结果：６０例中ＣＡＧ结果和ＭＰＩ结果不符合者１５例（２５％）。１５例病人平均年龄５２．７±９．５岁，男１１例，女４例。ＭＰＩ显示心肌缺血而ＣＡＧ正常者９例，其中临床诊断Ｘ综合征３例、陈旧性心肌梗塞１例、心绞痛（冠状动脉狭窄３０％～４０％）３例、高血压病２例；ＭＰＩ显示正常而ＣＡＧ有临床意义狭窄６例（狭窄５０％～６０％者６例次，累及右冠状动脉者３例次，分支狭窄者３例次，伴良好侧枝循环２例次）。结论：心肌灌注断层显像不正常而ＣＡＧ正常者，不能认为显像均为假阳性，其中有７８％的ＭＰＩ诊断与临床诊断符合；心肌显像阴性、ＣＡＧ证实狭窄≥５０％，大部分为冠状动脉远端分支狭窄和临界性冠状动脉狭窄及右冠状动脉狭窄。

Objectives: To analyze the unconformable results between myocardial perfusion SPECT and coronary angiography (CAG). Methods: The data of 60 in - patients who underwent myocardial perfusion SPECT and CAG were analyzed. Results: Among them, 15 patients,11 males and 4 females (average age 52.7 ±9.5 years old), had unconformable results of SPELT and CAG. Group A included 9 cases with myocardial ischemia on SPECT and normal coronary artery or coronary stenosis<50% on CAG, which were one case of old myocardial infarction, 3 cases of X syndrome, 3 cases with 30% - 40% coronary stenosis, 2 cases of essential hypertension. Group B included 6 cases with cases with normal SPECT and coronary stenosis≥50% on CAG.There were 6 cases with coronary artery stenosis between 50% - 60%, 3 right coronary artery stenosis, 3 terminal branches stenosis, 2 collateral circulation. Conclusions: It can not be considered that all abnormal SPECT without significant coronary stronary is false positive; while most of normal SPECT with significant coronary stenosis indicate terminal branch stenosis,coronaly stenosis between 50%- 60% on right coronary artery stenosis.