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目的:探讨同机心肌灌注显像和冠状动脉计算机断层摄影术(CT)成像融合影像技术评价冠状动脉病变的功能改变,及其在冠心病诊断中的临床价值。方法:30例可疑或确诊冠心病患者行同机负荷心肌灌注(myocardial perfusion imaging,MPI)和冠状动脉CT成像(coronary tomography coronary angiography,CTCA),负荷心肌灌注和CTCA按常规方法完成,利用融合软件整合冠状动脉解剖与心肌灌注功能影像,所有患者1个月内完成冠状动脉造影。负荷心肌灌注、CTCA和冠状动脉造影图像分别由2位以上有经验的核医学科和影像科、心内科和影像科医师判读;负荷-静息心肌灌注显示心肌“可逆性”缺损判为心肌缺血,显示心肌“不可逆性”缺损判为心肌梗死;冠状动脉造影及CTCA冠状动脉管腔狭窄≥50%定义为有临床意义。结果:基于冠状动脉血管及相应心肌供血区的对应关系,以冠状动脉造影或冠状动脉造影联合负荷心肌灌注作为标准对照,CTCA诊断冠心病的敏感性89.29%(25/28),特异性88.71%(55/62),阳性预测值78.13%(25/32),阴性预测值94.83%(55/58),准确性88.89%(80/90)。MPI诊断冠心病的敏感性70.73%(29/41),特异性81.63%(40/49),阳性预测值76.32(29/38),阴性预测值76.92%(40/52),准确性76.67%(69/90)。MPI/CTCA融合显像诊断冠心病,评价冠状动脉病变功能改变的敏感性96.43%(27/28),特异性90.32%(56/62),阳性预测值81.82%(27/33),阴性预测值98.25%(56/57),准确性92.22%(83/90)。结论:心肌灌注显像和CTCA融合影像技术评价冠状动脉病变功能改变,与单一影像技术比较,可明显提高冠心病及冠状动脉病变功能异常的诊断效能,并同时提供冠状动脉解剖及心肌血供功能信息,对冠状动脉疾病诊疗有较高的临床价值。
Objective: To investigate the functional changes of coronary lesion with the same myocardial perfusion imaging and coronary computed tomography (CT) imaging and its clinical value in the diagnosis of coronary heart disease. Methods: Thirty patients with suspicious or diagnosed coronary heart disease underwent cardiac perfusion imaging (MPI) and coronary tomography coronary angiography (CTCA). Myocardial perfusion and CTCA were performed by conventional methods. Fusion software Integration of coronary artery anatomy and myocardial perfusion imaging, all patients within 1 month to complete coronary angiography. Myocardial perfusion, CTCA, and coronary angiography were interpreted by more than two experienced nuclear medicine and imaging departments, cardiology and imaging physicians, respectively; load-resting myocardial perfusion showed myocardial “reversible” defects as Myocardial ischemia, showing myocardial “irreversible” defect as myocardial infarction; coronary angiography and CTCA coronary stenosis ≥ 50% defined as clinically significant. Results: Based on the corresponding relationship between coronary artery blood vessels and corresponding myocardial blood supply areas, coronary angiography or coronary angiography combined with myocardial perfusion as the standard control, CTCA diagnosis of coronary heart disease was 89.29% (25/28), specificity 88.71% (55/62), the positive predictive value was 78.13% (25/32), the negative predictive value was 94.83% (55/58) and the accuracy was 88.89% (80/90). The sensitivity of MPI in diagnosis of coronary heart disease was 70.73% (29/41), specificity was 81.63% (40/49), positive predictive value was 76.32 (29/38), negative predictive value was 76.92% (40/52), accuracy was 76.67% (69/90). The sensitivity and specificity of MPI / CTCA fusion imaging in the diagnosis of coronary heart disease were 96.43% (27/28), 90.32% (56/62), 81.82% (27/33), respectively. The negative predictive value Value of 98.25% (56/57), the accuracy of 92.22% (83/90). Conclusion: Myocardial perfusion imaging and CTCA fusion imaging can evaluate the function of coronary artery lesion. Comparing with single imaging, it can obviously improve the diagnostic efficacy of coronary heart disease and coronary artery disease. At the same time, it can provide coronary artery anatomy and myocardial blood supply Information, diagnosis and treatment of coronary artery disease have a higher clinical value.