心脏核医学NuclearCardiology.ppt

* * 66岁男性病人，偶发的心绞痛，2月前发展为诱发性的心绞痛。近来上下楼梯诱发心绞痛的发作。静息状态下ECG阴性。运动心电图发现ST段降低1毫米，但无胸痛的发作。 * 放支架和球囊扩张治疗。 Cardiac dea th or MI rate in pati ents with normal versus increased lung uptak e on exer cise TI-20 1 imaging stu dies. (Ada pted from [43].) Gill jB, * In patients with 2 mm furth er ST depression with exercise but sma ll or no perfusion defect s, the annualized ca rdiac death or MI rate was 1.4% per year compare d to 4.1% per yea r among patients with moderate to severely abnormal MPI (p 0.03). In high clinical risk subgroups, it may be beneficial to repeat risk stratification after 3 to 4 years, possibly sooner if they did not reach an ad equate heart rate on exercise testing. * Incremental prognostic value during diagnostic work-up. Information provided by stress/rest gated SPECT is available after clinical examination, laboratory tests, and ECG and echocardiography but before coronary arteriography. * Prognostic value during diagnostic work-up when information provided by gated SPECT is available after coronary arteriography. * * * Patient with stenoses of the left anterior descending coronary artery (LAD) and the right coronary artery (RCA), both classified as ≥50% on MDCT angiography. While RCA stenosis was associated with a reversible perfusion defect in the inferior wall, LAD stenosis showed no perfusion defect on gated SPECT. a Curved multiplanar reconstruction MDCT images showing the middle RCA segment with a non-calcified lumen reduction (left image, white arrow) and the middle LAD segment with a mixed plaque leading to “significant” stenosis (right image, yellow arrow). b Three-dimensional volume-rendered MDCT image showing the ascending aorta and the four proximal coronary arteries with significant stenoses in the middle RCA (white arrow) and the middle LAD (yellow arrow). c Axial (upper two rows, apex right) and sagittal SPECT slices at stress and rest (lateral right) showing a reversible perfusion defect in the inferior wall (white arrows) indicati