^(99m)Tc-MIBI心肌灌注断层显像在冠心病冠状动脉内支架置入术的应用

Clinical study of technetium-99m sestamibi SPECT with nitrate infusion in patients with coronary stent

目的 :应用硝酸甘油 (NTG)介入 ,单光子发射计算机断层显像 (SPECT)检查估测冠状动脉 (冠脉 )介入治疗前后存活心肌的大小、范围。方法 :对 42例冠心病患者行静息及NTG介入SPECT心肌显像检查 ,应用阅片计分法、极坐标靶心图定量分析法估测心肌活力。以 19例接受经皮腔内冠脉成形术 (PTCA)加冠脉内支架置入 (Stent)术后静息显像结果为“金标准” ,评价NTG介入显像对心肌活力检测效果。结果 :静息显像及NTG介入SPECT显像其不规则感兴趣区内放射性稀疏缺损面积、放射性计数、放射性异常计分差异有显著性意义 (t分别为 7.5 43、4.6 0 8、6 .76 2 ,均 P <0 .0 0 1)。静息显像检测出存活心肌为 5 6 .3% ,NTG介入显像为 6 9.6 %。NTG介入显像估测存活心肌准确率为阅片计分法 80 .9% ,定量分析法 90 .5 %。结论 :NTG介入SPECT检查可提高存活心肌检出率 。

Objective: To assess 99m Tc-sestamibi imaging (SPECT) with nitrate infusion to detect viable hibernating myocardial in patients with coronary stent. Method:Compared 99m Tc-sestamibi imaging with or without nitroglycerin (NTG) infusion to detect and estimate the size and scope of myocardial viability (MV) in patients with coronary heart disease before reperfusion and after coronary stenting. Result: 56.3% of MV was detected by resting SPECT, 69.6% of MV by NTG infusion SPECT. Accurate rate to detect MV using NTG infusion SPECT was 80.9% compared with that in visual checking, and 90.5% compared with that in bull's eye images. Conclusion: NTG infusion SPECT may be a useful approach for assessing viable myocardium.