心脏冠脉CTA对心肌桥的诊断学应用价值研究

目的:探讨心脏冠脉CTA对心肌桥的诊断学应用价值研究。方法:回顾性分析2017年1月-2019年12月在我院心内科治疗的1965例患者的临床资料,均行心脏冠脉CTA检查统计心肌桥诊出率,分析心肌桥与壁冠状动脉的关系。结果:1965例患者中,检出心肌桥470例,检出率为23.92%;470例心肌桥患者中,浅表型312例,深在型158例,浅表型肌桥的MB厚度、MCA狭窄程度均明显低于深在型肌桥(P<0.05)。结论:心脏冠脉CTA对心肌桥的诊断学应用价值显著,能有效检出心肌桥,明确心肌桥类型,准确显示心肌桥与壁冠状动脉的关系,为临床的诊治提供了可靠依据。     

心脏冠脉CTA后处理在心肌桥诊断中的价值

目的：探究心脏冠脉CT血管造影（CT angiography,CTA）后处理对于心肌桥的诊断价值。方法：选取2020年1月—2022年12月海安市中医院收治的冠心病患者55例为研究对象,所有患者均接受心脏冠脉CTA检查及心脏冠脉造影（coronary angiography,CAG）检查,以CAG诊断结果为金标准,分析心脏冠脉CTA检查在心肌桥诊断中的意义。结果：心脏冠脉CAG检查存在心肌桥异常27例,无异常28例;心脏冠脉CTA检查在心肌桥异常27例（真阳25例,假阳2例）,无异常28例（真阴26例,假阴2例）;心脏冠脉CTA检查灵敏度为92.59%(25/27),特异度为92.86%(26/28),准确率为92.73%(51/55)。Kappa=0.854,与金标准检验一致性较强;在心肌桥长度以及心肌桥狭窄程度比较中,两种检查方式的差异无统计学意义（P> 0.05）。结论：心脏冠状动脉CTA检查方式在心肌桥的诊断中具有较高的确诊率,且安全性更高,值得推广。     

64层螺旋CT血管成像与心肌灌注显像探测功能相关冠状动脉病变

目的 比较64层螺旋CT血管成像(CTA)和心肌灌注显像(MPI)对功能相关冠状动脉狭窄性病变的诊断价值.方法 回顾性分析20例确诊和11例拟诊冠状动脉病变(CAD)患者的64层CTA和MPI图像.按照目测直径法判断CTA图像上冠状动脉狭窄程度:≥50%或＜50%;相应MPI图像上的心肌缺血分为可逆性和固定性灌注异常区.结果 31例患者的124条冠状动脉中,23条CTA图像上狭窄≥50% ,其中7条(30.43%)狭窄血管的供血心肌在MPI上呈现灌注异常区;101条狭窄＜50%及正常,其中10条(9.90%)血管的供血心肌在MPI图像上呈现灌注异常区.冠状动脉狭窄程度与其供应心肌节段发生缺血的风险概率之间差异有统计学意义(χ2=6.667,P=0.01),而冠状动脉不同狭窄部位与其供应心肌节段发生缺血的风险概率之间差异无统计学意义(χ2=6.839,P=0.065).64层螺旋CTA在探测MPI图像上缺血心肌节段所对应的狭窄≥50%冠状动脉的敏感度、特异性、阴性预测值、阳性预测值分别为41.18%、85.05%、90.01%和30.43%.结论 64层螺旋CTA能清晰显示冠状动脉的重要形态学信息,但其探测功能相关狭窄≥50%冠状动脉的阳性预测值较低,而MPI则是评价CAD导致心脏功能改变的重要检查方法.     

静息门控断层心肌灌注显像在冠心病治疗抉择中的价值王 平,王远智,叶世琴,等

目的探讨静息门控断层心肌灌注显像在冠心病治疗抉择中的价值。方法54例心脏疾病患者,其中冠心病32例,动脉粥样硬化13例,其他心脏疾病9例（心肌桥3例、心肌病5例、x综合征1例）,均行静息门控断层心肌灌注显像检查,并与冠状动脉造影结果进行对比分析。结果静息门控断层心膪灌注显像阳性率分别为：冠心病组94％（30／32）、动脉粥样硬化组69％（9／13）、其他心脏疾病组100％（9／9）。结论静息门控断层心肌灌注显像可灵敏反映心肌血供状况及预估心肌活力,在心血管疾病,尤其是冠心病（CAD）的诊断、危险分层、疗效评估、预后判断和治疗方案的制定中有着非常重要的价值。应作为冠脉造影及支架安放或搭桥术前基础评估手段,避免盲目’过度治疗。     

冠脉造影与门控心肌断层显像结果差异分析

目的：对冠脉造影与门控心肌断层心肌显像检查结果不一致情况及影响因素进行分析。方法：对59例胸痛患者行冠脉造影及核素心肌灌注显像，并对结果不匹配者进行分析。结果：59例患者中，冠脉造影、核素心肌灌注显像结果不匹配者22例，其中男性16例，女性6例。门控心肌断层显像显示有心肌缺血而冠脉造影显示无明显冠状动脉病变患者有17例，门控心肌断层显像未见心肌缺血改变而冠脉造影显示有明显的冠状动脉狭窄的病人有5例。结论：对冠心病的诊断核素心肌灌注显像与冠脉造影的价值是互补的。     

心脏冠脉CTA后处理在心肌桥诊断中的价值

目的：探讨心脏冠脉CT血管造影（CTA）后处理在心肌桥诊断中的价值。方法：回顾性分析2021年5月—2023年6月在邳州东大医院就诊的100例接受心脏冠脉CTA检查的患者的临床资料,以冠脉造影结果为“金标准”,分析心脏冠脉CTA后处理诊断心肌桥的价值。结果：冠脉造影检查显示100例患者中40例出现心肌桥,心脏冠脉CTA后处理检出41例;心脏冠脉CTA后处理诊断心肌桥的准确率为93.00%,灵敏度为92.50%,特异度为93.33%,阳性预测值为90.24%,阴性预测值为94.92%;心脏冠脉造影与心脏冠脉CTA后处理检查的心肌桥长度与狭窄度,差异无统计学意义（P> 0.05）。结论：心肌桥诊断中心脏冠脉CTA后处理技术的应用效果确切,可为心肌桥的诊治提供有效参考。     

实时心肌超声造影在评价冠状动脉再通前后心肌血流灌注及随访中的价值

目的探讨心肌超声造影(MCE)在评价冠状动脉再通前后心肌灌注及其在临床随访中的应用价值。方法 36例患者均在冠状动脉再通前、后及随访6～12月分别行实时心肌声学造影检查,根据造影剂的充盈程度进行评分并与相应阶段造影和/或冠脉增强CT(CTA)结果进行对照分析。结果心肌超声造影后受损节段与未受损节段的对比增强,治疗前受损心肌的造影记分指数前后均低于正常心肌,冠脉再通后自身对照血流灌注明显改善,左室心内膜边界显示清晰。超声造影结果与再通治疗前冠脉造影符合率为88.9%(32/36),与再通治疗后靶血管供血支配区符合率为77.8%(28/36)。结论实时心肌超声造影可评价心肌微循环血流灌注,随访观察冠状动脉再通后心肌血流灌注改善情况,可以减少冠脉造影及CTA检查,避免副损伤和并发症。     

心肌灌注显像和冠状动脉造影的对照初评(附46例分析)

目的评价心肌灌注显像与冠状动脉造影间的相关性.方法对46例冠心病患者的冠脉造影狭窄定量测定结果和99mTc-MIBI静息心肌断层显像定性、定量分析结果进行比较.结果显示冠状动脉狭窄程度和相应心肌MIBI摄取定性、定量结果有良好的相关性,说明99mTc-MIBI心肌显像可间接地反映冠状动脉的血流状况,能较准确地预测冠状动脉的狭窄及其程度,可应用于冠心病的诊断、冠脉造影的筛选以及评判冠脉狭窄治疗前、后心肌血流灌注改善程度.     

多层螺旋CT血管造影在评价冠状动脉粥样硬化性心脏病患者心肌缺血程度中的价值

目的研究多层螺旋CT血管造影(MSCTA)在评价冠状动脉粥样硬化性心脏病(CAD)患者心肌缺血程度中的作用。方法选取初诊疑为冠心病的患者102例,分别采用MSCTA以及冠脉血管造影(CAG)检查,并以CAG诊断结果为"金标准",分析MSCTA诊断冠脉狭窄的敏感度、特异度、阳性预测值、阴性预测值以及准确度。同时,根据CAG结果将冠状动脉狭窄分为轻度狭窄、中度狭窄以及重度狭窄。此外,对所有患者进行核素心肌灌注显像检查,并计算CAG和MSCTA共同确诊的182支狭窄冠脉所匹配的心肌异常灌注区静息、负荷总积分以及灌注积分差。结果以CAG诊断为"金标准",102例患者MSCTA结果显示87例患者213支冠状动脉狭窄,诊断狭窄敏感性、特异性、阳性预测值、阴性预测值和准确度分别为97.17%,94.85%,96.71%,95.56%和96.26%;MSCTA诊断冠状动脉轻度狭窄率、中度狭窄率以及重度狭窄率分别为23.94%(51/213)、21.60%(46/213)、54.46%(116/213),与CAG22.53%(48/213)、19.25%(41/213)、54.93%(117/213)相比,均差异无统计学意义(均P>0.05)。轻度狭窄冠状动脉所匹配的心肌异常灌注区负荷总积分和灌注积分差低于中度狭窄以及重度狭窄,而中度狭窄冠状动脉所匹配的心肌异常灌注区心肌负荷总积分和灌注积分差又低于重度狭窄,均差异有统计学意义(均P<0.05)。经Spearman相关性分析,冠状动脉狭窄程度与心肌血流异常灌注区负荷总积分和灌注积分差呈显著正相关关系(r=0.758和r=0.636,均P<0.001)。结论 MSCTA可有效评价CAD患者的心肌缺血程度。     

心脏MRI与冠状动脉造影评价冠状动脉病变的对比研究

目的评价磁共振心脏成像(心脏MRI)由心肌活性间接判断冠状动脉病变的诊断价值.方法对55例临床怀疑冠状动脉硬化型心脏病的患者进行心脏MRI灌注及延迟强化扫描,间接诊断冠脉病变,并与冠脉造影结果进行对照.结果心脏MRI间接判断冠状动脉病变与冠脉造影结果无显著性差异.与冠脉造影相比,心脏MRI对于左前降支病变,诊断符合率92.7%,灵敏度91.8%,特异度100%;对于右冠状动脉病变,诊断符合率80%,灵敏度89.7%,特异度56.2%;对于回旋支病变,诊断符合率81.8%,灵敏度84.6%,特异度75.0%.结论心脏MRI由心肌活性间接判断冠状动脉病变具有重要的临床应用价值.     

腺苷负荷心肌灌注显像对冠心病的诊断价值

【目的】评价腺苷负荷试验心肌灌注显像对冠心病的诊断价值及腺苷负荷试验的安全性。【方法】收集2011年2月至2013年2月在本院疑诊冠心病患者75例,均行腺苷负荷^99m Tc-甲氧基异丁基异腈（MIBI）心肌灌注断层显像,腺苷按体重0．14 mg/（kg ·min）通过输液泵静脉双通路给药,并对心肌灌注断层显像图作定性分析,所有患者1～3 d后行冠状动脉造影检查。【结果】75例患者中冠脉造影正常32例;1支以上狭窄≥50％者43例,其中单支病变14例,双支病变16例,三支病变13例;共检出病变血管85支,累及左前降支（L AD ）38支,左回旋支（LCX）28支,右冠状动脉（RCA）21支,左主干（LM）2支。腺苷负荷心肌灌注显像诊断冠心病的灵敏度为88．3％（38/43）,特异性为87．5％（28/32）,准确性为88．0％（66/75）,阳性预测值为90．5％（38/42）,阴性预测值为84．8％（28/33）。对病变冠脉诊断灵敏度为75．9％（63/83）,特异性93．7％（133/142）,准确性87．1％（196/225）,阳性预测值为94．0％（63/67）,阴性预测值为84．2％（133/158）。对单支、双支、3支血管病变诊断的灵敏度分别为50％（7/14）、62．5％（10/16）和92．3％（12/13）。对各病变血管检测灵敏度为：LAD 86．1％（31/36）,LCX 55．6％（15/27）,RC A 85％（17/20）。腺苷不良反应总发生率为80％（60/75）。【结论】腺苷负荷试验心肌灌注显像诊断冠心病敏感性及特异性均较高,并且不良反应轻微,是协助诊断冠心病安全有效的方法。     

小剂量腺苷负荷低能量心肌声学造影定量评价冠心病心肌灌注的临床研究

目的探索小剂量腺苷负荷低能量心肌声学造影（MCE）的量化指标是否能够准确区分冠心病患者正常、缺血以及再灌注良好的心肌。方法在标准半量（70μg^-1·kg^-1·min^-1）的腺苷负荷条件下用声学造影剂SonoVue和对比脉冲顺序（CPS）成像技术对14例冠心病患者进行心肌声学造影检查,在心尖四腔、两腔切面采集负荷前、负荷后心肌造影图像。用量化分析软件测量拟合图像满意节段的灌注曲线,并计算峰值强度（A）、曲线斜率（β）和灌注量（A·β）。根据患者冠状动脉造影（CAG）或64排CT冠状动脉重建成像（CTA）结果将获得的心肌节段分为无明显狭窄组（第1组）、成功再血管化组（第2组）和严重狭窄组（第3组）,比较各组负荷前后灌注指标A、β和A·β的差异,以及在腺苷作用下各组灌注指标的变化量以及变化率。结果49节段心肌中第1组20段（20／49）,第2组12段（12／49）,第3组17段（17／49）;各组负荷前后灌注指标比较,负荷条件下第1组和第2组灌注增强;第2组和第3组灌注指标的变化量和变化率均低于第1组,第2组A·β增加量高于第3组,第3组在静息状态下灌注无明显减低,但负荷后A、A·β变化量低于第1组和第2组（P〈0．05）;腺苷负荷后A·β〈1．74dB／s诊断冠状动脉狭窄和灌注缺损的敏感性和特异性均为71％;腺苷负荷后A·β增加率〈81％诊断病变血管灌注储备降低的敏感性和特异性分别为83％和79％,β增加率〈54％敏感性和特异性分别为86％和79％。结论小剂量腺苷负荷的量化低能量心肌声学造影能够增加冠心病的临床诊断准确率及经皮冠状动脉介入术（PCI）疗效评价的准确性。其中量化诊断的指标A-β稳定性最好,负荷条件下B、A·β增加率也有较好的诊断价值。     

Non-invasive diagnosis of in stent stenosis by stress 99m technetium tetrofosmin myocardial perfusion imaging

Background The aim of this study was to assess the accuracy of stress 99m technetium tetrofosmin myocardial perfusion imaging for the diagnosis of in stent stenosis (ISS).Methods We studied 72 patients who underwent exercise or dobutamine stress 99m technetium tetrofosmin imaging, 0.9±0.5 years after percutaneous coronary interventions in which stents were deployed. Coronary angiography was performed within 3 months of the stress test. ISS was defined as ≥50% stenosis in a coronary segment with previous stenting. Significant coronary artery disease (CAD) was defined as ≥50% stenosis within or outside the stented coronary segment.Results The stent was deployed in 1 coronary artery in 52 patients, and in 2 coronary arteries in 20 patients (a total of 92 detected in 42 (58%) patients (51 stents). Reversible perfusion abnormalities were present in 34 of patients with ISS (sensitivity=81%, CI 70–94). Regional sensitivity for diagnosis of stenosis per stent was 76% (CI 65–88), specificity was 83% (CI 71–94) and accuracy was 79% (CI 69–85). Reversible perfusion abnormalities were detected in ≥2 vascular distributions in 15 of 22 patients with multi-vessel CAD and in 5 of 50 patients without (sensitivity for identifying multivessel CAD=68%, CI 50–89; specificity=90%, CI 82–98; and accuracy=83%, CI 75–90).Conclusion Stress 99m technetium tetrofosmin myocardial perfusion imaging is a useful non-invasive technique for the diagnosis of in stent stenosis and extent of CAD in patients with previous percutanenous coronary artery interventions.     

Anatomical versus functional assessment of coronary artery disease: direct comparison of computed tomography coronary angiography and magnetic resonance myocardial perfusion imaging in patients with intermediate pre-test probability

Computed tomography coronary angiography (CTA) and cardiac magnetic resonance myocardial perfusion imaging (CMR-MPI) are state-of-the-art tools for noninvasive assessment of coronary artery disease (CAD). We aimed to compare the diagnostic accuracy of CTA and CMR-MPI for the detection of functionally relevant CAD, using invasive coronary angiography (XA) with fractional flow reserve (FFR) as a reference standard, and to evaluate the best protocol integrating these techniques for assessment of patients with suspected CAD. 95 patients (68 % men; 62 ± 8.1 years) with intermediate pre-test probability (PTP) of CAD underwent a sequential protocol of CTA, CMR-MPI and XA. Significant CAD was defined as >90 % coronary stenosis, 40–90 % stenosis with FFR ≤ 0.80 or left main stenosis ≥50 %. Prevalence of significant CAD was 43 %. CTA was more sensitive (100 %) but less specific (59 %) than CMR-MPI (88 and 89 %, respectively) for detection of significant CAD, with a strong trend for higher global diagnostic accuracy of CMR-MPI (88 vs. 77 %, p = 0.05). An integrated approach based on an initial CTA and subsequent referral to CMR-MPI of positive/inconclusive results had the best diagnostic performance (AUC 0.91). The direct referral to XA of patients with positive/inconclusive CTA performed worse than a selective approach based on CMR-MPI results (AUC 0.80 vs. 0.91, p = 0.005). In this intermediate PTP population, CMR-MPI showed a strong trend toward better performance compared to CTA for the assessment of functionally significant CAD. A combined protocol integrating coronary anatomy and function seems to be a very effective approach in the accurate diagnosis of CAD.     

腺苷超声与核素心肌显像推测心绞痛相关狭窄血管的比较

目的 比较腺苷超声心动图与腺苷核素心肌灌注显像诊断冠心病及推测稳定型心绞痛患者相关狭窄血管的价值。方法 51例临床诊断为稳定型心绞痛的住院患者同期进行腺苷超声心动图与腺苷核素心肌灌注显像检查,超声心动图示室壁运动障碍,心肌显像检测核素分布稀疏或缺损,并在2周内行冠状动脉造影对照。结果 51例患者接受冠状动脉造影,诊断冠心病42例,9例排除冠心病,诊断狭窄血管74支。超声心动图阳性者33例,心肌显像阳性者39例。超声心动图诊断狭窄血管敏感性62%,特异性86%,准确性75%。核素心肌显像诊断狭窄血管敏感性80%,特异性89%,准确性84%。二者诊断符合率84%。结论 研究结果显示,与腺苷超声心动图诊断稳定型心绞痛患者狭窄血管相比较,腺苷心肌灌注显像具有更高的敏感性,尤其识别多支病变及中重度狭窄血管更敏感。     

Diagnostic accuracy of quantitative cardiac MRI evaluation compared to stress single-photon-emission computed tomography

Background: Cardiac MRI (cMRI) perfusion is a promising non-invasive tool to assess myocardial ischemia. The accuracy of quantitative cMRI perfusion has been recently demonstrated, but to date no previous study has compared this technique with stress single-photon-emission computed tomography (SPECT). The aim of this study was to evaluate the diagnostic accuracy of myocardial perfusion reserve (MPR) based on cMRI compared with SPECT. Methods: We examined 24 patients who underwent coronary angiography, stress SPECT and cMRI perfusion. Qualitative assessment of both SPECT and cMRI images, quantification of cMRI perfusion, and quantitative coronary angiography (QCA) were independently performed. MPR was calculated using Fermi deconvolution technique. Accuracy of quantitative and qualitative data was examined to detect > 50% diameter stenosis (DS) by QCA. Results: Qualitative analysis was obtained in 198 segments and quantitative analysis was performed in 171 segments. Significant coronary artery disease (CAD) was present in 81.8% of patients. Visual cMRI assessment yielded sensitivity of 74.4% and specificity of 79.4% to predict > 50%DS, while SPECT showed sensitivity of 67.4% and specificity of 81.3%. The sensitivity for SPECT in the right coronary artery territory and apex was low compared to cMRI. Sensitivity and specificity for detection of significant CAD were 89.5% and 46.6% for MPR (cutoff 1.92). Area under the curve was 0.75 for MPR (P < 0.01). Conclusions: The diagnostic accuracy of qualitative examination of perfusion cardiac MRI and stress SPECT were comparable. The high sensitivity and low operator dependency of quantitative cMRI makes it an attractive tool to evaluate myocardial perfusion.     

128层螺旋CT冠状动脉成像技术在冠心病诊断中的临床应用

目的:探讨128层螺旋CT(SCT)在冠状动脉狭窄诊断中的临床应用价值。材料与方法:对临床怀疑或诊断冠心病的104例患者行128层SCT冠状动脉成像检查(CTA)并评价冠状动脉狭窄程度。对有意义(50%)的患者行导管法冠状动脉数字减影检查(DSA),并与CTA评价结果进行比较。结果:26例患者CTA未见明显狭窄,42例轻度狭窄,17例中度狭窄,19例重度狭窄及闭塞,共检出30例(28%)心肌桥;47例患者行导管法DSA,共检出9例(19%)心肌桥,其中6例患者CTA评价狭窄程度较DSA偏轻。结论:128层螺旋CTA对冠状动脉狭窄的诊断准确性较高,可用于冠状动脉狭窄的初步诊断和介入治疗的筛选。     

心肌灌注显像在女性冠心病诊断中价值

目的评价心肌灌注显像对女性冠心病患者的诊断价值。方法 344例有胸痛、胸闷症状女性患者,行静息+药物负荷心肌灌注显像检测,并与冠状动脉造影结果进行对比分析。结果冠状动脉狭窄178例患者中心肌灌注显示异常者130例;冠状动脉造影无异常或不规则166例中心肌灌注显像异常50例,无异常116例;以冠状动脉造影结果为标准,心肌灌注显像对女性冠心病诊断的敏感度、特异度、阳性预测值、阴性预测值分别为73.0%,69.9%,72.2%,70.7%。结论心肌灌注显像对女性冠心病患者的诊断及是否进一步行冠状动脉造影的筛选有一定价值。     

Magnetic resonance perfusion imaging in patients with coronary artery disease: a qualitative approach

Although contrast-enhanced first pass magnetic resonance imaging (MRI) has potential to quantify blood flow through extensive image post-processing, clinical utility is likely to depend on rapid qualitative analysis. Aims: To investigate use of an on-line analytical approach for detection of coronary artery disease (CAD). Methods and results: Thirty subjects with CAD underwent contrast-enhanced rest/adenosine stress MRI with basal, mid-papillary and apical short-axis image acquisition. Each short axis was divided into eight regions of interest (ROI). Regional perfusion was visually classified as normal or impaired according to transmural distribution and defect reversibility. MRI and angiographic data were compared. Qualitative MRI reporting was possible for 98% ROI. Eighty-six coronary artery (CA) territories were assessed of which 71 (83%) had stenoses. Sensitivity and specificity for detection of stenoses were 93 and 60%, respectively. The proportion of hypoperfused ROI rose from 31% with <50% stenosis to 65% with occlusion. More transmural defects were seen in infarction-related territories (75 vs. 54%, p < 0.05). More ROI demonstrated defect reversibility in occluded rather than in stenosed infarction-related vessels (89 vs. 58%, p < 0.05). Occluded vessels with grade 2–3 collaterals contained a higher proportion of normal ROI (44 vs. 25%, p < 0.05). Conclusions: Qualitative MRI analysis had high sensitivity and moderate specificity for detecting CA stenoses. Additional information was obtained relating to lesion severity, previous infarction, myocardial viability and impact of collateral circulation. The technique has potential for de novo diagnosis of CAD and as a complementary modality to angiography to assess the significance of given angiographic lesions.