SPECT联合冠状动脉造影在冠状动脉性心脏病诊治中的作用

Combination of radionuclide myocardial imaging and coronary angiography in diagnosis and management of coronary artery disease

目的:探讨99mTc-MIBI单光子发射计算机断层显像(single photon emission computed tomography,SPECT)联合冠状动脉造影(coronary angiography,CAG)对冠状动脉性心脏病(coronary artery disease,CAD)的诊疗价值。方法:2009年7月～2012年6月南京医科大学第二附属医院就诊的176例疑似CAD患者,行CAG或CAG联合SPECT检查。根据卫生部冠心病诊断标准并结合CAG和SPECT检查结果,选择性进行经皮冠状动脉成形术(percutaneous transluminal coronary angioplasty,PTCA)或冠状动脉旁路移植术(coronary artery bypass graft surgery,CABG)。术后1～3个月复查SPECT,对比SPECT和CAG检查结果,分析两者在术前诊断和术后随访中的作用和意义。结果:176例均接受CAG检查,其中113例同时完成SPECT检查。诊断为CAD138例,CAG诊断敏感性93.4%(129/138)、特异性97.4%(37/38)、准确性94.3%(166/176);SPECT敏感性85.2%(69/81)、特异性90.6%(29/32)、准确性86.7%(98/113);CAG联合SPECT检查(其中任一项异常即视为阳性)的敏感性100%(81/81)、特异性87.5%(28/32)、准确性96.5%(109/113)。65例(其中PTCA 63例,CABG 2例)在接受治疗后3个月内完成SPECT随访,其手术前后室壁收缩增厚率和左室射血分数变化率与胸痛症状改善相关。结论:CAG联合SPECT检查可以提高CAD诊断的敏感性和准确性;SPECT对于CAD术后随访具有直观、量化、可重复和便捷的优势,并可以反映临床症状的改善情况。

Objective：To explore the usefulness of 99m Tc-MIBI single photon emission computed tomography（SPECT）combined with coronary angiography（CAG） in diagnosis and management of coronary artery disease（CAD）.Methods：One hundred and seventy-six suspected patients with coronary artery disease underwent CAG or CAG plus SPECT.The management strategy and revascularization procedure（Percutaneous transluminal coronary angioplasty vs.coronary artery bypass graft surgery ） were prospectively selected on the basis of a combination of CAG,SPECT and the approval of diagnostic criteria of CAD of the Ministry of Health.Patients received PTCA or CABG were retested with SPECT in 1 ～3 months after treatment.The results were compared for exploring the role and significance of them in preoperative diagnosis and postoperative follow-up for CAD.Results：A total of 176 patients underwent CAG,of which 113 patients were performed SPECT for one week before CAG.The results showed that 138 patients of CAD were found from them.The results of patients with CAD were analyzed,the diagnostic sensitivity,specificity and accuracy of CAG were 93.4%（129/138）,97.4%（37/38）and 94.3%（166/176）,respectively.The ratios of SPECT were 85.2%（69/81）, 90.6%（29/32）and 86.7%（98/113）and of CAG ＋ SPECT（as long as one is abnormal,it should be deemed positive） were 100%（81/81）, 87.5%（28/32）and 96.5%（109/113）,respectively.Sixty-five patients received SPECT within 3 months after treatment（PTCA 63, CABG 2）.It was showed that △STR and △LVEF（Percentual Systolic Wall Thickening and left ventricular ejection fraction change between pre-and post-operation）were related to chest pain relief of CAD patients.Conclusion： Combination of SPECT and CAG can improve the diagnostic sensitivity and accuracy of CAD;SPECT can be intuitive,quantifiable,repeatable and convenient to reflect the improvement of clinical symptoms of CAD patients after treatment.