SPECT／CT融合影像探究冠心病心肌灌注异常与冠状动脉狭窄的相关关系

Evaluation of correlation between myocardial perfusion abnormality and coronary artery stenosis with SPECT/CT

目的运用核素MPI与CTCA融合影像技术，研究冠心病患者心肌血流灌注异常与冠状动脉（简称冠脉）狭窄之间的相关性。方法回顾性分析169例MPI阳性冠心病患者[男102例，女67例，年龄7～80（56．1±12．1）岁]的核素MPI与同机CTCA影像资料，重建心肌与冠脉的融合影像，匹配出心肌灌注异常区及其供血冠脉。根据MPI17节段靶心图，对各节段心肌进行5级评分。计算静息总积分、负荷总积分、灌注积分差，并根据负荷总积分分为轻度、中度、重度灌注异常组。采用Spearman相关分析各组心肌灌注异常区域负荷积分、灌注积分差与冠脉狭窄程度的关系。结果169例患者中，轻度、中度和重度灌注异常分别有89、37和43例；共发现心肌灌注异常区180个，其中轻度、中度和重度灌注异常组分别有89、42和49个。灌注异常区的供血冠脉中，20支正常，狭窄〈25％23支，狭窄25％-50％28支，狭窄51％～74％55支，狭窄75％-99％47支，7支闭塞。心肌血流灌注异常区域负荷积分、灌注积分差与冠脉狭窄程度均呈正相关（rs=0．617和0．435，均P〈0．05）。在轻度、中度、重度灌注异常组，负荷积分与冠脉狭窄程度的Spearman相关系数L分别为0．456、0．652和0．417，灌注积分差与冠脉狭窄程度的-分别为0．332、O．491和O．305。结论SPECT／CT融合影像技术可用于诊断功能相关冠脉病变。在中度灌注异常组中，心肌血流灌注异常与冠脉狭窄的关系更为密切。

Objective To investigate the correlation between myocardial perfusion abnormality and coronary artery stenosis using MPI and CTCA. Methods A total of 169 patients （ 102 males, 67 females, age： 7-80 （56.1±12.1） years） who underwent MPI and CTCA were enrolled. MPI and CTCA images were fused, then myocardial perfusion abnormal areas and corresponding coronary arteries were found. According to bull＇s-eye map, myocardial segments were scored by a 5-grade criteria and summed stress score （SSS）, summed rest score （SRS）, summed difference score （SDS） were obtained. All subjects were divided into mild, moderate and severe groups according to the SSS. The correlation between abnormal area and coronary artery stenosis was analyzed by Spearman rank correlation analysis. Results The mild, moderate and se- vere groups had 89, 37 and 43 subjects respectively, and numbers of abnormal areas were 89, 42, and 49 respectively in the 3 groups. Among the supplying coronary arteries of abnormal areas, 20 were normal, 23 with stenosis〈25%, 28 with stenosis 25%-50%, 55 with stenosis 51%-74%, 47 with stenosis 75%-99%, 7 totally occluded. The correlations between SSS, SDS of perfusion abnormal area and coronary artery steno- sis were significant （rs = 0.617, 0.435, both P〈0.05）. In mild, moderate and severe groups, the correlation coefficients between SSS and coronary artery stenosis were 0.456, 0.652 and 0.417, the correlation coeffi cients between SDS and coronary artery stenosis were 0.332, 0.491, 0.305. Conclusions The SPECT/CT fusion technology is helpful in diagnosis of functionally relevant coronary artery lesions. In moderate group, the correlation between myocardial perfusion abnormality and coronary artery stenosis is more significant.