冠状动脉支架植入前后及术后半年^(99)Tc^m-MIBI心肌断层显像定量分析

Quantitative analysis of ^(99) Tc^m-MIBI myocardial perfusion images before and after intracoronary stenting

目的 通过对冠状动脉 (简称冠脉 )支架植入前后进行99Tcm 甲氧基异丁基异腈 (MIBI)心肌断层显像 ,以了解心肌灌注缺损程度、范围 ,判断SPECT在术前筛选、术后疗效评价、后期随访中的价值。方法 对 5 1例冠心病患者冠脉支架植入前后和 2 1例植入后半年 ,分别做静态和潘生丁负荷SPECT检查 ,定量分析心肌灌注缺损的部位、程度及范围。结果 术前 5 0例中 ,心肌血流灌注程度 >80 % (灌注缺损程度 <2 0 % )、灌注缺损范围 <2 0 % (比值越大 ,灌注缺损面积越大 )者为 0例 ;术后 1周有 7例灌注缺损程度、8例灌注缺损面积已完全正常 (14%和 16 % ) ;术前严重灌注缺损 <49%的 34例 (6 8% ) ,术后 1周 16例 (32 % )有改善 ;术前严重灌注缺损面积 >70 %的 35例 ,术后 1周 10例有改善 ,急性心肌梗死改善更明显。术前和术后 1周静态SPECT心肌灌注程度 38 0 5 %和 5 7 40 % ,改善 19 35 % ,术前和术后 1周静态SPECT心肌灌注缺损面积为 70 75 %和 5 5 91% ,改善 14 74% ,在术后 1周及半年心肌灌注缺损程度、灌注缺损面积均有明显改善 (P <0 0 0 1)。而术前、术后 1周及术后半年潘生丁负荷SPECT心肌灌注缺损程度、灌注缺损面积与术前、术后 1周及术后半年静息SPECT心肌灌注缺损程度、灌注缺损面积差异无显著性 (<3%

Objective Assessing the value of 99 Tc m MIBI myocardial perfusion imaging (SPECT) in selection of patients for stenting,and in evaluation of the therapeutic effects of the procedure and its value for following up of the patients with coronary artery stents Methods Rest and dipyridamole stress SPECT were performed in 51 patients with coronary artery diseases and coronary artery stents one week before procedure, one week and half a year (21 cases) after procedure The location, degree and area of blood flow deficit were quantitively analyzed Results Before the procedure,50 patients showed blood flow deficit degree >80%(the lower the percentage,the more the blood flow deficit degree), blood flow deficit area < 20%(the higher the percentage, the larger the blood flow deficit area) One week after the procedure, 7 (14%) of the patients who had been with blood flow deficit degree > 80%, 8 (16%) patients who had been with blood flow deficit area < 20% no longer showed any blood flow deficit Thirty five patients showed blood flow deficit area > 70% before the procedure, 10 (20%) of them one week after procedure were without any severe blood flow deficit Their acute myocardial infarctions were significantly improved Pre procedure, at rest, the blood flow deficit degree was 38 05%, at one week after procedure became 57 40%,it was improved by 19.35% The patients with blood flow deficit area of 70 75% at rest before the procedure, showed a deficit area of 55.91% one week after the procedure.Compared to pre procedure readings, the significant improvement (P<0 001) in blood flow deficit degree and area were found one week and half a year after procedure No significant difference (<3%,P>0 05) in blood flow deficit degree and area between rest and dipyridamole stress SPECT before or one week, half a year after procedure Conclusions The blood flow deficit degree or area measured by SPECT were improved one week and half a year after procedure.SPECT is valuable in selection of patients for the procedure and in evaluation of the effect of the therapy and it is very useful during follow up of the patients with intracoronary stents