排螺旋CT间接预测心肌缺血临床应用.docVIP

64排螺旋CT间接预测心肌缺血的临床应用 作者：任峰，付强，徐健，李先进 【摘要】 　　目的： 探讨64排螺旋CT冠状动脉造影﹙CT angiography，CTA﹚诊断冠脉狭窄的程度与单光子发射计算机断层扫描（single photon emission computed tomography，SPECT）心肌灌注显像﹙myocadiac perfusion imaging,MPI﹚诊断相关狭窄动脉所支配的心肌血流灌注状况之间的对应关系。方法： 112例可疑冠心病的胸痛患者在1周内均行CTA及99mTcMIBI﹙甲氧基异丁基异腈﹚MPI。比较不同狭窄程度的冠脉与相关狭窄动脉所支配的心肌血流灌注之间的关系。结果： 分别以冠脉狭窄≥50%及≥70%为诊断心肌缺血的阳性标准。以患者作为比较对象，CTA预测心肌缺血的敏感性、特异性、阳性预测值、阴性预测值分别为88%,52%,74%，74%和76%,86%,90%，70%；以病变血管作为比较，CTA预测心肌缺血的敏感性、特异性、阳性预测值、阴性预测值分别为92%,73%,66%，94%和47%,94%,82%，76%。结论： CTA诊断的冠脉狭窄程度≥70%时与相应的MPI显示心肌缺血之间的一致性较高，而狭窄在50%～70%的患者中两者的结果差异较大。 【关键词】 心肌灌注显像； 64排螺旋CT ； 冠心病 　　［Abstract］Objective: To evaluate spiral multidetector computed tomography（MDCT） angiography using 64slice technique in the detection of functionally relevant coronary artery stenoses（CAS）. Methods： One hundred and twelve patients with suspected coronary artery disease were investigated using 64slice MDCT angiography and myocardial perfusion imaging with 99mTcMIBI SPECT within one week.Stenoses with luminal narrowing of ≥50% were defined as “significant” in MDCT. MDCT angiography was compared with the detection of functionally relevant CAS. Results： In patientbased analysis, stenoses with luminal narrowing of ≥50% were defined as “significant” in MDCT,then the sensitivity, specificity,positive and negative predictive values of MDCT angiography in detecting reversible perfusion defects on SPECT were 88%, 52%, 74% and 74%;Respectively, stenoses with luminal narrowing of ≥70% were defined as “significant” in MDCT,then the sensitivity, specificity,positive and negative predictive values of MDCT angiography in detecting reversible perfusion defects on SPECT were 76%, 86%, 90% and 70%. In vesselbased analysis, stenoses with luminal narrowing of ≥50% were defined as “significant” in MDCT,then the sensitivity, specificity,positive and negative predictive values of MDCT angiography in detecting reversible perfusion defects on SPECT were 92%, 73%, 66% and 94%, respectively, stenoses with lumi