^(99)Tc^m-tetrofosmin与^(99)Tc^m-MIBI心肌显像的对比研究

A Comparative study of ^(99)Tc^m-tetrofosmin and ^(99)Tc^m-MIBI myocardial imaging

目的 评价99Tcm 1,2 双 [双 2 乙氧乙基膦 ]乙烷 (tetrofosmin)诊断冠心病的临床价值。方法 经冠脉造影、病历资料完整的 5 3例患者 ,其中行99Tcm tetrofosmin心肌灌注显像 2 7例 ,行99Tcm MIBI心肌灌注显像 2 6例。运动负荷试验按Bruce方案进行。Tetrofosmin显像于给药后 30min行心肌断层显像 ,间隔 2 4h后作静息心肌断层显像 ,运动 静息一日法则在 4h后作静息心肌断层显像 ;MIBI显像于给药后 1～ 2h行心肌断层显像 ,48h后作静息心肌断层显像。冠脉造影采用Judkins法。结果 99Tcm tetrofosmin心肌灌注显像 ,运动、静息显像以及运动 静息一日法心肌显像均获得了清晰的心肌断层图像 ,均未发现邻近器官有明显的放射性干扰。Tetrofosmin诊断冠心病的灵敏度为 90 % ,MIBI的诊断灵敏度为 94% ,两者间差异无显著性 (P >0 .0 5 )。Tetrofosmin的检测效率为 85 .2 % ,MIBI的检测效率为88.5 % ,两者间差异无显著性 (P >0 .0 5 )。Tetrofosmin和MIBI的阳性预测值分别为 90 .0 %和 89.5 % ,诊断特异性分别为 71%和 75 %。结论 99Tcm tetrofosmin心肌显像对冠心病心肌缺血具有较高的诊断价值 ,且适用于运动

Objective To evaluate the value of 99 Tc m tetrofosmin myocardial imaging for detecting coronary artery disease. Methods Twenty seven patients underwent 99 Tc m tetrofosmin SPECT, twenty six patients underwent 99 Tc m MIBI SPECT;coronary angiography was performed on patients included in both groups (≥50% luminal diameter stenosis was considered significant coronary stenosis). Results 99 Tc m tetrofosmin produced high quality myocardial images from 30 min to several hours postinjection, the outlines of myocardial perfusion images provided by 99 Tc m tetrofosmin imaging were clearly discernible. One day exercise/rest 99 Tc m tetrofosmin myocardial perfusion imaging was feasible and had a high sensitivity for detection of coronary artery disease. Sensitivities of 99 Tc m tetrofosmin SPECT and 99 Tc m MIBI SPECT for detecting coronary artery disease were 90% and 94%, respectively. The 95% confidence limits of both sensitivities were 68.65%～98.77% and 72.33%～99 86%, respectively; the positive predictive values of both imaging agents were 90.0% and 89.5%, respectively, the 95% confidence limits of those were 68.38%～98.77% and 66.38%～98.70%, respectively; efficiencies of both imaging agents were 85.2% and 88.5%, respectively. The 95% confidence limits of both efficiencies were 65 81%～95.78% and 69.44%～98.70%, respectively. The specificity for both imaging agents was 71% and 75%. There was no significant difference among above results( P >0.05). No ECG abnormalities were found following the injection of 99 Tc m tetrofosmin SPECT. There were no drug related effects on blood pressure, heart rate and body temperature. This experiment failed to provide the negative predictive value of the myocardial perfusion imaging with 99 Tc m tetrofosmin because that few patients with normal coronary artery were included in the study. Conclusions Myocardial perfusion imaging with 99 Tc m tetrofosmin or 99 Tc m MIBI gives diagnostic information comparable to each other in patients undergoing one day exercise/rest protocal for assessment of coronary artery disease. One day exercise/rest myocardial perfusion with 99 Tc m tetrofosmin is clinically feasible in detecting coronary artery disease.