不同冠状动脉优势型对SPECT心肌灌注显像图像影响的研究

Influence of different coronary vessel dominance on myocardial perfusion imaging by SPECT

目的分析不同冠状动脉优势型患者的SPECT心肌灌注显像(MPI)图像是否存在差异。方法回顾性分析2019年8月至2022年6月于云南省阜外心血管病医院行运动负荷/静息SPECT MPI的97例冠脉优势型患者的临床资料,其中男性52例、女性45例,年龄(55.9±11.5)岁。冠状动脉优势型由冠状动脉造影或冠状动脉增强CT判定。按照冠状动脉优势型将患者分为2组:显性右冠优势型组(78例);非显性右冠优势型组(19例),包括左冠优势型和均衡型患者。采用美国心脏协会17节段法分析2组患者的MPI图像,计算各心肌节段负荷/静息灌注评分和灌注差异评分。2组间灌注评分的比较采用Wilcoxon秩和检验。结果97例患者中,63例(64.9%)患者的MPI图像出现不同程度的放射性分布减低。非显性右冠优势型组患者的总负荷灌注总评分(SSS)、总静息灌注总评分(SRS)、总差异灌注总评分(SDS)均高于显性右冠优势型组患者[2(1,4)分对1(0,2)分、1(1,2)分对(0(0,1))分、0(0,2)分对0(0,0)分],且差异有统计学意义(Z=2.969、−2.945、−2.109,均P<0.05)。2组患者在心尖、前壁、侧壁、间隔的SSS、SRS、SDS的差异无统计学意义(Z=−1.108~0.000,均P>0.05),但在下壁的SSS、SRS、SDS以及出现心肌缺血的阳性率中,非显性右冠优势型组患者明显高于显性右冠优势型组患者,其中非显性右冠优势型组下壁的SSS、SRS、SDS分别为1(0,3)、0(0,2)、0(0,1)分,高于显性右冠优势型组下壁的0(0,0)、0(0,0)、0(0,0)分,且差异均有统计学意义(Z=−3.093、−2.938、−2.813,均P<0.05)。非显性右冠优势型组患者下壁阳性率(4/19,21.1%)高于显性右冠优势型组(5/78,6.4%),且差异有统计学意义(χ^(2)=3.892,P=0.049)。结论不同冠状动脉优势型患者的SPECT MPI图像存在差异,非显性右冠优势型患者下壁的灌注评分更高,提示当MPI图像出现下壁轻度放射性分布稀疏时,可能需要参考冠状动脉优势型的信息,以减少可能的假阳性诊断。

Objective To assess the influence of coronary vessel dominance on myocardial perfusion imaging(MPI)by SPECT.Methods A total of 97 patients who performed exercise stress/rest SPECT MPI in Fuwai Yunnan Hospital,Chinese Academy of Medical Sciences from August 2019 to June 2022 were retrospectively analyzed.The patients included 52 males and 45 females,aged(55.9±11.5)years.Coronary dominance was determined by coronary angiography or coronary artery contrast CT.They were divided into two groups according to the coronary vessel dominance:a dominant right coronary artery group(DRCA,n=87)and a non-dominant right coronary artery group(NDRCA,n=19),including a left-dominant coronary artery and a balanced coronary artery.The American Heart Association 17-segment model was used to analyze the MPI images of the two groups of patients,and the differences in stress/resting perfusion scores of each myocardial segment were calculated.The Wilcoxon rank-sum test was used to compare the differences in perfusion scores between the two groups.Results Among the total of 97 patients,63(64.9%)showed radioactive uptake defects on the MPI images.The summed stress score(SSS),summed rest score(SRS),and summed difference score(SDS)in the NDRCA group were significantly higher than those in the DRCA group:SSS(2(1,4)vs.1(0,2)score),SRS(1(1,2)vs.0(0,1)score),and SDS(0(0,2)vs.0(0,0)score).The differences were statistically significant(Z=−2.969,−2.945,and−2.109,respectively;all P<0.05).There were no significant differences in the scores of the apical,anterior,lateral,and septal walls between the two groups(Z=−1.108 to 0.000,all P>0.05).The perfusion scores and ischemia rate in the inferior wall were significantly higher in the NDRCA group.Among them,the SSS,SRS,and SDS of the inferior wall of the NDRCA group were 1(0,3)、0(0,2)and、0(0,1)score,respectively,which were significantly higher than those of the DRCA group at 0(0,0)、0(0,0)and 0(0,0)score,the differences were statistically significant(Z=−3.093,−2.938,and−2.813,respectively;all P<0.05).The positive rate of inferior wall myocardial ischemia in the NDRCA group(4/19,21.1%)was higher than that in the DRCA group(5/78,6.4%),and the differences were statistically significant(χ^(2)=3.892,P=0.049).Conclusions A significant difference in myocardial perfusion was found between patients with varied coronary vessel dominance.Patients with NDRCA had higher perfusion scores in the inferior wall on SPECT MPI.This result indicates that when the inferior wall presents a mild radioactive uptake defect,information about coronary vessel dominance may need to be considered to reduce the potential for false-positive diagnoses.