SPECT心肌灌注显像和CCTA诊断冠心病心肌缺血的价值比较

Value of SPECT Myocardial Perfusion Imaging and CCTA in Diagnosing Myocardial Ischemia of Coronary Heart Disease

目的比较单光子发射型计算机断层(SPECT)心肌灌注显像和冠脉CT血管成像(CCTA)对冠心病心肌缺血的诊断价值。方法选取2017年6月-2018年10月因冠心病或疑似冠心病而进行冠脉造影(CAG)、CCTA和SPECT心肌灌注显像患者34例为研究对象,以CAG为金标准,评价CCTA和SPECT心肌灌注显像对冠心病心肌缺血的诊断效能。结果CCTA检出患者24例(70.59%),检出主要冠脉50支(49.02%);SPECT心肌灌注显像检出可逆性缺损者20例(冠脉36支)。以CAG为金标准,根据患者例数,CCTA诊断灵敏度95.65%,特异度81.82%,SPECT心肌灌注显像诊断灵敏度82.61%,特异度90.91%;根据冠脉支数,CCTA诊断灵敏度88.37%,特异度79.66%,SPECT心肌灌注显像诊断灵敏度72.09%,特异度91.52%。结论CCTA诊断冠心病心肌缺血具有较高的灵敏度和阴性预测值,SPECT心肌灌注显像诊断冠心病心肌缺血具有较高特异性和阳性预测值,两者互为补充,综合判断可提高诊断准确性。

Objective To compare the diagnostic value of single photon emission computed tomography(SPECT)myocardial perfusion imaging and coronary computed tomography angiography(CCTA)for myocardial ischemia of coronary heart disease(CHD).Methods 34 patients who completed coronary angiography(CAG),CCTA and SPECT myocardial perfusion imaging for CHD or suspicion of CHD between June 2017 and October 2018 were selected as the study subjects.With CAG as the golden standard,the diagnostic efficiencies of CCTA and SPECT myocardial perfusion imaging for myocardial ischemia of CHD were evaluated.Results CCTA detected 24 patients(70.59%)and 50 main coronary arteries(49.02%).SPECT myocardial perfusion imaging detected 20 patients with reversible defects(36 coronary arteries).With CAG as the golden standard,according to the number of patients,the diagnostic sensitivity and specificity of CCTA were 95.65%and 81.82%.The diagnostic sensitivity and specificity of SPECT myocardial perfusion imaging were 82.61%and 90.91%.According to the number of coronary arteries,the diagnostic sensitivity and specificity of CCTA were 88.37%and 79.66%.The diagnostic sensitivity and specificity of SPECT myocardial perfusion imaging were 72.09%and 91.52%.Conclusion The sensitivity and negative predictive value of CCTA in the diagnosis of myocardial ischemia of CHD are high.The specificity and positive predictive value of SPECT myocardial perfusion imaging are high.The two can complement each other,and comprehensive judgment can improve the diagnostic accuracy.