心肌灌注显像结合冠状动脉CT血管造影在冠心病诊治中的应用价值

目的探讨心肌灌注显像(MPI)结合冠状动脉CT血管造影(CTA)对冠心病诊断及准确定位"罪犯"血管的价值。方法收集2012年2月—2013年12月住院的冠心病患者33例,男25例,女8例,年龄35⁷5(55.2±20.2)岁,均行75(55.2±20.2)岁,均行⁽¹³⁾N-NH_3PET腺苷负荷/静息MPI及冠状动脉CTA检查,1个月内完成冠状动脉造影(CAG),分别对MPI、CTA及CAG结果进行分析,以CAG结果为金标准,分析冠状动脉CTA、MPI及MPI联合冠状动脉CTA的诊断价值。结果(1)冠状动脉CTA诊断冠心病的灵敏度为90.0%(36/40)、特异度为95.0%(302/318)、阳性预测值为69.2%(36/52)、阴性预测值为98.7%(302/306)。(2)MPI诊断冠心病的灵敏度为90.9%(20/22)、特异度为90.9%(10/11)、阳性预测值为95.2%(20/21)、阴性预测值为83.3%(10/12)。(3)MPI联合冠状动脉CTA诊断冠心病的灵敏度为95.5%(20/21)、特异度为100%(11/11)、阳性预测值为100%(21/21)、阴性预测值为91.7%(11/12)。结论 MPI结合冠状动脉CTA可减少单纯MPI或CTA造成的"假阳性"和"假阴性",为冠心病的诊治提供更高准确性,尤其是提高了对"罪犯血管"的检出率。

Myocardial perfusion imaging combined with computed tomography coronary angiography in the diagnosis and treatment of coronary heart disease

Objective To investigate myocardial perfusion imaging （MPI） combined with coronary CT angiography （CTA） in diagnosis of “culprit” coronary artery. Methods From 2012 February-2013 December, hospitalized patients with coronary heart disease （33 cases） were enrolled, male of 25 cases, female of 8 cases, age from 35 to 75 years old （55.2 ±20.2 ） , they were underwent13 N-NH3 PET adenosine / resting MPI and coronary artery CTA examination, within 1 months of coronary arteriography （CAG）, respectively. The MPI, CTA and CAG were analyzed; using CAG as golden standard, the di- agnostic value of coronary CTA, MPI and MPI combined coronary artery CTA were analyzed. Results （ 1 ） The sensitivity of CTA in diagnosis of coronary heart disease was 90.0% （36/40）, the specificity was 95.0% （302/318）, the positive predic- tive value was 69.2% （36/52）, the negative predictive value was 98.7% （302/306）. （2） The sensitivity of MPI in diagno- sis of coronary heart disease was 90.9% （20/22）, the specificity was 90.9% （10/11）, the positive predictive value was 95.2% （20/21）, the negative predictive value was 83.3% （10/12）. （3） The sensitivity of MPI combined with CTA in diag- nosis of coronary heart disease was 95.5% （20/21）, the specificity was I00% （ 11/11 ）, the positive predictive value was 100% （21/21）, the negative predictive value was 91.7% （11/12）. Conclusion MPI combined with coronary CTA can de- crease the “false positive” and “false negative” results caused by MPI or CTA alone, provides higher accuracy for the diagno- sis and treatment of coronary heart disease, especially to improve the detection rate of “culprit” vessel.