扩张性心肌病和缺血性心肌病心肌灌注、代谢及功能的综合评价

Application of radionuclide techniques in evaluation of dilated cardiomyopathy and ischemic cardiomyopathy

目的 探讨核素显像在扩张性心肌病 (DCM)和缺血性心肌病 (CAD CM)诊断及鉴别诊断中的作用。方法 对 2 8例DCM和 5 5例CAD CM均行99Tcm 甲氧基异丁基异腈 (MIBI)静息心肌灌注SPECT及1 8F 脱氧葡萄糖 (FDG)心肌代谢PET显像 ,其中 73例行核素心室显像 ,6 8例做冠状动脉造影。结果 心肌灌注显像 2 3例 (82 % )DCM为不呈节段分布的、散在的稀疏 ,4例 (14% )有灌注缺损 ;5 2例 (95 % )CAD CM心肌灌注呈节段性异常 ,其中 45例 (82 % )有灌注缺损 ;平均半定量得分DCM组为 (4 5± 2 6 )分 ,CAD CM组 (9 5± 2 9)分 ,P <0 0 0 1。极坐标定量分析灌注摄取严重减低面积在DCM组与CAD CM组分别为 (15 7± 12 8) %和 (35 3± 15 4) % ,P <0 0 0 1。心肌代谢显像DCM组中 2例 (7% )有代谢缺损 ,CAD CM组中 18例 (33 % )有代谢缺损。灌注 代谢显像DCM组大多数表现一致 ,CAD CM组灌注 代谢不匹配者多见 (77% )。DCM组和CAD CM组LVEF均降低 ,无统计学差异。RVEF在DCM组和CAD CM组分别为 (32 4± 13 9) %和 (4 0 9± 15 4) % ,P <0 0 5。结论 多项参数对鉴别诊断有意义 。

Objective To assess the clinical significance of radionuclide techniques in differentiating dilated cardiomyopathy (DCM) from ischemic cardiomyopathy (CAD CM) Methods 28 patients (pts) with DCM and 55 pts with CAD CM were studied All pts underwent 99 Tc m MIBI myocardial perfusion SPECT and 18 F FDG myocardial metabolic PET 73 pts had 99 Tc m RBC radionuclide ventriculography and 68 pts had coronary angiography Results 23 pts (82%) with DCM showed perfusion abnormalities with mild and not segmental distribution 52 pts (95%) with CAD CM showed perfusion abnormalities that distributed along the coronary vessel territories Perfusion defects were found in 4 pts (14%) with DCM and 45 pts (82%) with CAD CM (P<0 01) The average perfusion score was 4 5±2 6 in DCM and 9 5±2 9 in CAD CM, the area of perfusion diminished uptake was significantly smaller in DCM than in CAD CM (P<0 001) 2 pts with DCM and 18 pts with CAD CM had metabolic defect The patterns of perfusion/metabolic imaging showed mismatch in most pts with CAD CM but match in pts with DCM The LVEF in pts with DCM and CAD CM was decreased but no significant difference between DCM and CAD CM was observed The RVEF in pts with DCM was significantly lower than that in pts with CAD CM (32 4%±13 9% vs 40 9%±15 4%, P<0 05) Conclusions The radionuclide techniques showed to be helpful for distinguishing DCM from CAD CM The discriminate analysis revealed that segmental perfusion abnormality and RVEF were the most important factors for differentiation of DCM from CAD CM