单光子发射断层与透射断层图像融合探查心肌灌注和冠状动脉钙化在老年患者中的临床价值

The clinical value of myocardial perfusion imaging and coronary artery calcification with fusion imaging by acquisition by SPECT/CT in detection of coronary artery disease in elderly patients

目的 探讨正电子发射断层与透射断层（SPECT/CT）一站式采集获得门控心肌血流灌注（MPI）和冠状动脉钙化（CAC）图像在老年患者中的应用价值. 方法 前瞻性研究2012年10-12月133例冠心病确诊或待诊者,以SPECT/CT行门控MPI和CAC扫描.根据年龄和MPI将入选者分为老年组与非老年组、MPI正常组和异常组.以系统软件算出CAC积分（CACS）,并根据CACS分为0分组、1～9分组、10～99分组、100～399分组和≥400分组.数据行两独立样本Mann-Whitney U检验、Kruskal-Wallis单因素AVOVA检验、x2检验或Fisher确切概率法. 结果 MPI异常组CAC阳性率高于正常组,72.6％（69/95）与52.6％（20/38）,P＜0.05;MPI异常组的CACS也高于MPI正常组,（386.8±815.0）分与（56.5±109.0）分（P＜0.01）,CACS≥400分组的MPI异常率高于其余4组（均P＜0.01）;CACS≥400分组心肌受累节段数高于其余4组（P＜0.05或P＜0.01）,其余组间比较差异无统计学意义（P＞0.05）;CAC预测心肌缺血或梗死的灵敏度为72.6％（69/95）,特异度为47.4％（18/38）,准确度为65.4％（87/133）.老年组CACS（356.7±790.0）分高于非老年组（89.7±233.0）分（P＜0.01）;老年组CAC预测心肌缺血或梗死的灵敏度为79.7％（59/74）,高于非老年组的47.6％ （10/21）,P＜0.01;特异度低于非老年组,37.0％ （10/27）与72.7％（8/11）,P＞0.05. 结论 SPECT/CT一站式MPI CAC检查模式简便易行,老年人提供冠状动脉与心肌血流灌注全面信息的同时,也为准确探查心肌缺血、梗死提供了一个更好的信息平台.但由于老年患者通常有更显著的CAC,应提高CAC诊断阈值以提高MPI-CAC诊断特异性.

Objective To investigate the clinical value of myocardial perfusion imaging （MPI） and coronary artery calcification （CAC） with one-stop-shop acquisition by SPECT/CT in detection of coronary artery disease （CAD） in elderly patients.Methods The 133 patients with suspected or diagnosed CAD who underwent gated MPI and CAC scan by SPECT/CT during October 2012 to December 2012 were prospectively studied.All patients were divided into elderly group （aged ≥60 years） and non-elderly group （aged〈60 years）,normal MPI group and abnormal MPI group,and 0,1-9,10-99,100-399,≥400 subgroups according to CAC scores （CACS）.Mann-Whitney U test,Kruskal-Wallis one-way AVOVA test,x2 test,Fisher＆#39;s exact test were performed for statistical analysis.Results CAC positive rate and CACS were higher in normal MPI group than in abnormal MPI group [72.6% （69/95） vs.52.6% （20/38）,（386.8±815.0）scores vs.（56.5±109.0）scores,P〈0.05 or 0.01].The abnormal MPI rate was higher in CACS ≥400 group than in the other four CACS groups （P〈0.05 或 P〈0.01）,there was no significant difference between the other four CACS groups （P〉0.05）.The sensitivity,specificity and accuracy of CAC in detection of myocardial ischemia or infarction were 72.6% （69/95）,47.4% （18/38）,65.4% （87/133）,respectively.The CACS was higher in elderly group than in non-elderly group[（356.7 ± 790.0）scores vs.（89.7± 233.0）scores,P〈0.01].The sensitivity of CAC in detection of myocardial ischemia was higher in elderly group than in non-elderly group [79.7% （59/74） vs.47.6% （10/21）,P〈0.01],while the specificity in elderly group had a decreased tendency as compared with non-elderly group [72.7% （10/27） vs.37.0% （8/11）,P〉0.05].Conclusions One-stop-shop acquisition of MPI and CAC by SPECT/CT is convenient.MPI-CAC SPECT/CT may offer comprehensive information on both myocardial perfusion and CAC and provide a better information platform for the accurate exploration of myocardial ischemia and infarction in clinic,especially for the elderly patients.However,due to usually more severe CAC in elderly patients,we should enhance the diagnostic cutoff score in order to obtain a higher diagnostic specificity of MPI-CAC.