~(99m)Tc-MIBI门控心肌灌注断层显像检测冠心病的准确性

目的　评价 99m Tc- MIBI门控心肌灌注断层显像估价冠心病 (CAD)的准确性 ,以及门控心肌灌注断层显像显示心肌损害与冠脉造影的关系。方法　对 93例受检者进行了运动 /静息 99m Tc- MIBI门控心肌灌注断层显像 ,其中 47例有冠脉造影检查 ,冠状动脉狭窄 >50 %为 CAD诊断标准。结果　检测 CAD的灵敏度为 84.84% ,特异性为 85.71 % ,准确性为 92 .0 0 %。正常人组的正常符合率 94%。检测 LAD病变的灵敏度为84.62 % ,LCX为 77.77% ,RCA为 85.71 %。检测 L AD病变的准确性 79% ,LCX为 77% ,RCA为 82 %。 1 2例冠脉造影显示 50 %～ 70 %狭窄者与心肌灌注显像的相关性较差 (r=0 .33,P=NS)。 2 1例冠脉造影显示 >70 %狭窄者与心肌灌注显像有良好的相关性 (r=0 .0 5,P<0 .0 5)。结论　 99m Tc-MIBI门控心肌灌注断层显像可以准确地检测冠心病 ,在避免冠脉造影检查风险方面 ,对老年病人更有实际应用价值     

Technetium-labeled myocardial imaging agents

^99mTe sestamibi and^99mTc teboroxime has unique features that differ from thallium-201 in dosimetry, energy, cellular transport, extraction fraction, retention, washout, and imaging protocols. Sestamibi is ideal for gated and SPECT imaging while SPECT imaging with a multi-head detector system is preferred for teboroxime. Both permit simultaneous assessment of perfusion and function using first-pass radionuclide angiography. This paper discusses the special features and clinical applications of these two technetium agents.     

腺苷负荷试验心肌灌注显像在老年人冠心病中的临床应用

目的 评价腺苷负荷试验心肌灌注显像在诊断老年人冠心病的准确性及临床应用的特点.方法 63例临床疑诊冠心病或已诊断但病情不稳定需介入治疗老年患者,住院后分别行腺苷负荷试验心肌灌注显像和冠状动脉(冠动)造影检查.腺苷负荷试验心肌灌注采用单光子发射断层显像图像采集系统,腺苷以140μg·kg-1·min-1静脉注射,用药时间6 min,注射过程中全程监测心电图、血压及患者的症状.于注射腺苷3 min末,静脉注射核素显像剂99cm Tc-MIBI 925 MBq,1.5 h后行心肌灌注断层显像,若显像异常,次日行静息心肌显像.冠脉造影按常规程序,在腺苷负荷试验心,肌灌注显像前后1周内进行.结果 63例中,53例冠脉造影阳性,10例阴性,而腺苷负荷试验心肌灌注显像51例阳性,7例阴性.腺苷负荷试验心肌灌注显像诊断老年人冠心病的总体敏感性为96.2%,特异性为70.0%,阳性预测值94.4%,阴性预测值77.8%,准确性为92.1%.53例冠脉造影显示,冠脉狭窄病变中,单支病变29例,二支14例,三支10例;累及左前降支(LAD)44支,左回旋支(LCX)18支,右冠脉(RCA)25支.腺苷负荷试验心肌灌注显像判断血管病变以LAD敏感性最高,达到95.5%;RCA次之,为84.0%;LCX最差,仅为55.6%;但特异性可达100%.监测过程中,32例(50.0%)患者发生胸闷、胸痛、头晕、头痛等不良反应,无严重事件发生.结论 腺苷负荷心肌灌注显像诊断老年人冠心病的敏感性、特异性高,尤其对探查和定位严重的冠脉病变准确性更高;腺苷负荷试验过程中副作用小,且因检查无创,因此在老年人冠心病的临床诊断应用中具有重要的价值.     

A head-to-head comparison of the coronary calcium score by computed tomography with myocardial perfusion imaging in predicting coronary artery disease

Objective The coronary artery calcium (CAC) score has been shown to predict future cardiac events. However the extent to which the added value of a CAC score to the diagnostic performance of myocardial perfusion imaging (MPI) by single photon emission computed tomography (SPECT) is unclear. The purpose of this study is to investigate the correlation between CAC score and SPECT in patients with suspected coronary artery disease. Methods A retrospective review of the CAC scores by use of the Agatston calcium scoring method and cardiac SPECT diagnostic reports was conducted in 48 patients, who underwent both coronary computed tomography (CT) and SPECT examinations due to suspected coronary artery disease. A Pearson correlation test was used to determine the relation between CAC scores and MPI-SPECT assessments with regard to the evaluation of the extent of disease. Results Forty-seven percent of the patients had CAC scores more than 100, while 42% of these patients demonstrated abnormal, or probably abnormal, MPI-SPECT. Of the 23% of patients with a zero CAC score, only 7% had normal MPI-SPECT findings. No significant correlation was found between the CAC scores and MPI- SPECT assessments (r value ranged from 0.012 to 0.080), regardless of the degree of coronary calcification. Conclusions There is a lack of correlation between the CAC scores and the MPI-SPECT findings in the assessment of the extent of coronary artery disease. CAC scores and MPI-SPECT should be considered complementary approaches in the evaluation of patients with suspected coronary artery disease.     

99mTc-MIBI门电路SPECT对冠心病的诊断和心肌存活性评价的作用

为进一步评价99m锝-甲氧基异睛(99mTc-MIBI)门电路和非门电路单光子发射断层显像(SPECT)对冠心病的诊断价值及硝酸甘油介入诊断试验在心肌存活状态评价中的作用,对40例进行运动心肌灌注断层显象,并与冠状动脉(冠脉)造影比较.结果32例冠脉造影显示冠脉有意义狭窄.门电路断层显象对冠心病诊断总的敏感和特异性分别为93.8%和87.5%;非门电路断层显象分别为84.4%和87.5%,两相比较,无显著性差异(P＞0.05).对冠脉病变支数诊断敏感性门电路方法优于非门电路方法(分别为73.8%和62.3%,P＜0.05).特异性均为96.6%.20例进行含服硝酸甘油后静态心肌灌注断层显象,16例心肌梗死病人中有3例为部分可逆性心肌灌注缺损,4例慢性心肌缺血病人,全部有可逆性心肌灌注.表明硝酸甘油介入诊断试验有助于心肌灌注异常可逆性的评估;99mTc-MIBI门电路SPECT和硝酸甘油介入诊断试验是有效的对冠心病无创性诊断和心肌存活状态评价方法.     

Myocardial perfusion imaging in coronary artery disease

Radionuclide myocardial perfusion imaging (MPI) can be used to demonstrate the presence of coronary heart disease and to risk stratify and guide management of patients with known disease. It has the ability to localize hemodynamically important coronary stenoses, and assess the extent and severity of coronary obstruction by the presence and extent of perfusion defects. A normal stress MPI indicates the absence of coronary obstruction and hence of clinically significant disease. Cardiac PET has the advantage from SPECT of higher spatial and temporal resolution, and a decreased radiation exposure to patients. Hybrid cardiac imaging combining SPECT or PET with CT data appears to offer superior diagnostic and prognostic information in patients with intermediate risk for CAD. A significant progress in better quantification of myocardial blood flow and coronary flow reserve has recently been seen. Also several studies have demonstrated that the combination of imaging apoptosis and matrix metalloproteinases production can help imaging vulnerable plaque and identifying the group of high-risk asymptomatic patients who will benefit most by an imaging procedure.     

~(99m)TC-MIBI心肌显像与超声心动图对冠心病危险性的分级预测价值

目的探讨心肌显像（ＭＩＢＩ）与超声心动图（ＵＣＧ）对冠心病危险性的分级预测价值。方法对１７４例怀疑和已知冠心病患者进行ＭＩＢＩ和ＵＣＧ检查,分为正常、缺血、梗塞和缺血＋梗塞,将患者分为心脏事件发生组和无心脏事件组,分析ＭＩＢＩ和ＵＣＧ显像与心脏事件发生的关系。结果ＭＩＢＩ和ＵＣＧ检测相同率较高（６５．５％）,ＭＩＢＩ和ＵＣＧ异常者易发生心脏事件,两者均异常者心脏事件发生率最高（３０％）。结论 ＭＩＢＩ和ＵＣＧ相关性良好,结合应用时ＵＣＧ异常可增加ＭＩＢＩ的危险性分级预测能力。     

磁共振心肌灌注成像对老年冠心病的诊断价值

目的　探讨磁共振心肌灌注成像对老年冠心病的诊断价值。方法　对临床确诊的 35例冠心病患者 ,利用磁共振心肌灌注成像方法得到心肌灌注时间 -信号强度曲线 ,观察曲线的上升斜率和信号强度的峰值。并同期作了冠脉造影 ,确定心肌异常改变与冠脉病变血管分布相对应关系。结果　 33例经心肌灌注成像有 41个病灶呈低灌注区为心肌缺血 ,其中 5例出现延迟强化为心肌梗死 ,经冠脉造影证实 35例均有不同程度的冠脉狭窄。结论　磁共振心肌灌注成像与冠脉造影检查结果无明显差异 ,具有高度的一致性。而磁共振心肌灌注成像是一种无创性测定心肌血流的检查方法 ,为及时诊断及恰当治疗冠心病提供可靠的依据     

心脏双能量CT与负荷/静息心肌灌注显像和冠状动脉造影的对比研究

目的:探讨心脏双能量CT对冠状动脉狭窄和心肌灌注缺损的诊断价值。方法:34例临床可疑或已知冠心病患者行心脏双能量CT检查。重建冠状动脉CTA图像(dual-energy CT angiographyDE-CTA)和双能心肌灌注图(dual-energy CT perfusion DE-CTP)用于冠状动脉狭窄程度和心肌灌注缺损的评判,并与冠状动脉造影和负荷/静息心肌灌注显像(single photo emission computed tomographySPECT)为参考标准,评价心脏双能量CT对冠状动脉狭窄程度和心肌灌注缺损诊断的灵敏度、特异度、阳性预测值及阴性预测值。结果:1.28例符合纳入标准的患者进入本研究;2.DE-CTA显示408段冠状动脉,其中44段冠状动脉狭窄≥50%,以冠状动脉造影为参考标准,DE-CTA诊断冠状动脉狭窄的灵敏度、特异度、阳性预测值及阴性预测值分别为89.28%、97.70%、86.20%及98.29%,准确性为96.58%;3.DE-CTP显示心肌节段476段,其中90段显示心肌灌注缺损,以负荷/静息心肌灌注显像为参考标准,DE-CTP诊断心肌灌注缺损的灵敏度、特异度、阳性预测值及阴性预测值分别为85.71%、93.09%、74.07%及96.58%,准确性为91.71%,DE-CTP诊断心肌灌注缺损与负荷/静息心肌灌注显像,诊断心肌灌注缺损具有较好的一致性,kappa值0.74(P<0.001)。结论:双能量CT作为一项新的成像方法,不仅能够诊断冠状动脉狭窄,还能对病变冠状动脉的血流动力学改变做出准确判断。     

CT冠状动脉造影结合腺苷负荷核素心肌灌注显像诊断冠心病的应用价值

目的 探讨CT冠状动脉造影(CTCA)结合腺苷负荷核素心肌灌注显像(MPS)、解剖学成像结合功能学成像,无创全面诊断冠心病的可行性与准确性.方法 105例怀疑或诊断为冠心病的患者,在有创性冠状动脉造影(CAG)检查前4周内完成CTCA与腺苷负荷MPS检查.以CAG结果为参照,分别评价CTCA、负荷/静息MPS及CTCA结合MPS诊断冠心病的可行性、准确性及特点.结果 CTCA诊断冠状动脉阻塞性病变的敏感性为97.1%,特异性为75.0%,阳性预测值为8 8.2%,阴性预测值为93.1%,准确性为89.5%;负荷/静息MPS诊断冠状动脉阻塞性病变的敏感性为79.7%,特异性为63.9%,阳性预测值为80.9%,阴性预测值为62.2%,准确性为74.3%;CTCA结合MPS诊断阻塞性冠状动脉病变的敏感性为97.2%,特异性为98.5%,阳性预测值为98.5%,阴性预测值为89.7%,准确性为95.2%.结论 CTCA结合腺苷负荷MPS可以明显提高CTCA诊断冠心病的特异性及阳性预测值,且解剖学结合功能学成像可全面提供冠心病的诊断信息.

Abstract：

Objective To assess the accuracy and feasibility of combination of CT coronary angiography (CTCA) and adenosine stress myocardial perfusion scintigraphy (MPS) for diagnosis of coronary artery disease (CAD). Methods CTCA, MPS were performed in 105 patients with suspected or diagnosed CAD within 4 weeks before coronary angiography (CAG) examination. Results The sensibility,specificity, positive predictive value ( PPV ), negative predictive value ( NPV ) and accuracy were 97. 1%,75.0%, 88.2%, 93.1% and 89. 5%, respectively, for CTCA; 79.7%,63.9%,80.9%,62.2% and 74. 3%, respectively, for MPS and 97. 2% ,98. 5% ,98. 5% ,89. 7% and 95.2%, respectively, for CTCA +MPS. Conclusion Combination of CTCA and adenosine stress MPS, which provided both anatomical and functional information of coronary vessels, could significantly increase the specificity and PPV of diagnosing CAD with CTCA.     

320排动态容积CT冠状动脉成像与心肌灌注成像的相关性研究

目的探讨320排动态容积CT冠状动脉成像(computed tomography coronary angiography,CTCA)显示的冠状动脉狭窄程度与CT心肌灌注成像(CT myocardial perfusion imaging,CT-MPI)显示的心肌灌注缺损之间的相互关系。方法对60例冠状动脉疾病患者行CTCA及CT-MPI检查,将其结果进行统计学处理,并进行Spearman等级相关分析。结果 CTCA显示冠状动脉左前降支(left anterior descending,LAD)、左回旋支(left circumflex artery,LCX)、右冠状动脉(right coronary artery,RCA)180支,其中正常冠状动脉56支,狭窄冠状动脉124支。按照LAD、LCX、RCA三支冠状动脉供血范围统计,CT-MPI显示86支冠状动脉灌注正常,94支冠状动脉存在灌注缺损。结论冠状动脉狭窄程度与心肌灌注缺损存在正相关的关系。     

Efficacy of full-fat milk and diluted lemon juice in reducing infra-cardiac activity of 99mTc sestamibi during myocardial perfusion imaging

Background

When using ^99mTc sestamibi for myocardial perfusion imaging, increased splanchnic activity creates a problem in the visual and quantitative interpretation of the inferior and infero-septal walls of the left ventricle. We sought to determine whether the administration of diluted lemon juice or full-fat milk would be effective in reducing interfering infra-cardiac activity and therefore result in an improvement in image quality. We compared the administration of full-fat milk and diluted lemon juice to a control group that had no intervention.

Methods

The study was carried out prospectively. All patients referred to our institution for myocardial perfusion imaging from November 2009 to May 2012 were invited to be enrolled in the study. A total of 630 patients were randomised into three groups. Group 0 (G0), 246 patients, were given diluted lemon juice, group 1 (G1), 313 patients, were given full-fat milk, and group 2 (G2), 71 patients, had no intervention (control group). A routine two-day protocol was used and the patients were given the same intervention on both days. Raw data of both the stress and rest images were visually assessed for the presence of infra-cardiac activity, and quantitative grading of the relative intensity of myocardial activity to infra-cardiac activity was determined. The physicians were blinded to the intervention received and the data were reviewed simultaneously.

Results

The overall incidence of interfering infra-cardiac activity at stress was 84.1, 84.5 and 96.6% in G0, G1 and G2, respectively (p = 0.005). At rest it was 91.7, 90.1 and 100% in G0, G1 and G2, respectively (p = 0.0063). The visual and quantitative results favoured both milk and lemon juice in reducing the amount of interfering infra-cardiac activity versus no intervention.

Conclusion

The administration of milk or lemon juice resulted in a significant decrease in the intensity of infra-cardiac activity compared to the control group. This reduction in intensity was even more significant in the milk group for patients assessed during rest myocardial perfusion imaging.     

冠脉64排螺旋CT与腺苷负荷心肌灌注显像对冠心病的诊断价值

目的：探讨冠脉64排螺旋CT（CTA）与腺苷负荷心肌灌注显像对冠心病的诊断价值。方法：入选临床诊断或疑诊为冠心病的患者66例,以冠状动脉造影作为冠心病诊断的金标准,所有患者均进行冠脉64排螺旋CT,腺苷负荷心肌灌注显像与冠状动脉造影检查。结果：与冠状动脉造影比较,64排螺旋CT对冠心病诊断的敏感性为87.10%（27/31）,特异性为97.14%（34/35）,准确性为92.42%（61/66）,腺苷负荷心肌灌注显像敏感性为93.55%（29/31）,特异性为85.71%（30/35）,准确性为89.39%（59/66）。冠脉64排螺旋CT与腺苷负荷心肌灌注显像在诊断冠心病的准确性上无显著差别（P〉0.05）。结论：冠脉64排螺旋CT与腺苷负荷心肌灌注显像诊断冠心病的准确性无显著差别,结果可靠,应予推广。     

149例核素心肌灌注SPECT与冠状动脉造影对照的研究

目的运动-静态核素心肌灌注影像对冠心病诊断灵敏度、特异性和准确性评价。方法149例核素心肌血流灌注显像，123例运动-静态心肌显像，（99mTc－MIBI103例，201TI20例），26例心肌梗塞者仅静态99mTc－MIBI心肌显像，采用运动-静态心肌断层影像定性分析和Bulls－eye定量分析，以双盲法回顾性病例分析，与冠状动脉造影结果对照。结果核素心肌灌注显像对冠心病诊断灵敏度90．l％，特异性82．3％，准确性86．5％，阳性预测率85．8％，阴性预测率87．5％，假阳性率17．6％，假阴性率9．8％；单支、双支、三支血管病变心肌显像灵敏度分别为94．5％、85．0％、87．5％；冠状动脉血管狭窄50％-75组与>75%，心肌灌注缺血组之间显著性差异（t=6．35，P＜0．05）。结论运动-静态核素心肌灌注显像是灵敏和准确的评价局部心肌血供和活体心肌功能影像检查方法。     

腺苷负荷试验心肌灌注显像对冠心病的诊断价值

目的:分析腺苷负荷试验心肌核素显像对于冠心病诊断的敏感性、特异性及其特点,评价其诊断冠心病的临床价值.方法:对68例临床疑诊冠心病患者,将其腺苷负荷试验心肌灌注显像结果与冠状动脉造影(CAG)结果进行对比分析.结果:在68例患者中,36例CAG阳性,其中腺苷心肌灌注显像检出病变33例(91.7%),未检出病变3例(8.3%);32例CAG阴性,其中腺苷心肌灌注显像异常3例(9.4%),正常29例(90.6%);腺苷心肌灌注显像对冠心病诊断的敏感性92.3%,特异性90.6%.结论:腺苷核素心肌灌注显像诊断冠心病敏感性及特异性均较高,是协助诊断冠心病的有效的无创性检查方法.     

心肌灌注核素显像、平板运动心电图及动态心电图在冠心病中的意义

目的：探讨心肌灌注核素显像（ECT）,平板运动心电图（TET）及动态心电图（DEG）对冠心病的诊断价值。方法：以冠状动脉造影为冠心病诊断的金标准,对80例冠心病患同步进行ECT,TET及DEG,并作对比分析,结果：ECT的阳性率（91．3％）明显高于TET（77．5％）,DEG（62．5％）,TET的阳性率明显高于DEG,而DEG的特异性（86．5％）,明显高于TET能较好地反映心肌缺血的程度和部位,DEG有较高的特异性。     

Identification of hemodynamically significant coronary artery stenoses by dipyridamole-magnetic resonance imaging and99mTc-methoxyisobutyl-isonitrile-SPECT

Magnetic resonance imaging (MRI) has been used in conjunction with dipyridamole induced wall motion abnormalities for the noninvasive detection of coronary artery disease (CAD). To assess the clinical usefulness of dipyridamole-MRI for the localization of CAD and to evaluate the relation between dipyridamole induced wall motion abnormalities and myocardial perfusion 33 patients with severe CAD (>70% diameter reduction) underwent MRI at rest and after dipyridamole infusion (0.75 mg dipyridamole/kg over a period of 10 minutes). All patients performed exercise stress testing and 20 patients of the study group additionally had rest and exercise stress^99mTc-methoxyisobutyl-isonitrile-SPECT (MIBI-SPECT). Two patients (6%) could not be evaluated due to severe motion artifacts during dipyridamole MRI.Segmental wall motion and perfusion of corresponding short axis planes were related to the major coronary arteries using a standardized segmental coronary artery perfusion pattern. Detection of wall motion abnormalities or perfusion defects by 2 blinded observers in consensus was the criterion for grading a segment normal or pathologic. For localization of CAD, segmental gradings were related to the presumed coronary artery territories.Stress-ECG was pathologic in 19/31 patients yielding a sensitivity of 61% and dipyridamole induced angina was present in 68% (21/31) of patients. Dipyridamole-MRI detected coronary artery disease with a sensitivity of 84% (26/31 patients) and all patients with new wall motion abnormalities also had dipyridamole induced angina. For the subgroup of 20 patients with MIBI-SPECT images, CAD was detected by both MIBI-SPECT and Dipyridamole-MRI in 90% (18/20) of patients. Dipyridamole-MRI and MIBI-SPECT gradings agreed in 55/60 (92%) coronary artery perfusion territories. There were no significant differences with respect to the sensitivities of Dipyridamole-MRI/MIBI-SPECT for the localization of individual coronary artery stenoses yielding 81%/78% for left anterior descending, 80%/80% for left circumflex and 92%/89% for right coronary artery stenoses. However, specificity of Dipyridamole-MRI (89%) for the detection of RCA stenoses was slightly better than for MIBI-SPECT (80%).Dipyridamole-MRI induced regional wall motion abnormalities proved to be a highly sensitive parameter for the non-invasive localization of CAD. The similarity of dipyridamole-MRI and MIBI-SPECT results suggests a close agreement between functional and perfusion parameters in the assessment of hemodynamically significant coronary artery stenoses. The clinical utility of this MRI stress test is still limited by high cost and long imaging times which may, however, be overcome by the development of new shorter imaging sequences.Abbreviations CAD coronary artery disease - MRI magnetic resonance imaging - MIBI-SPECT 99mTc-methoxyisobutyl-isonitrile-SPECT     

Impact of hypertension on the accuracy of exercise stress myocardial perfusion imaging for the diagnosis of coronary artery disease

AIM—To compare the accuracy of exercise stress myocardial perfusion single photon emission computed tomography (SPECT) imaging for the diagnosis of coronary artery disease in patients with and without hypertension.
METHODS—A symptom limited bicycle exercise stress test in conjunction with 99m technetium sestamibi or tetrofosmin SPECT imaging was performed in 332 patients (mean (SD) age, 57 (10) years; 257 men, 75 women) without previous myocardial infarction who underwent coronary angiography. Of these, 137 (41%) had hypertension. Rest SPECT images were acquired 24 hours after the stress test. An abnormal scan was defined as one with reversible or fixed perfusion defects.
RESULTS—In hypertensive patients, myocardial perfusion abnormalities were detected in 79 of 102 patients with significant coronary artery disease and in nine of 35 patients without. In normotensive patients, myocardial perfusion abnormalities were detected in 104 of 138 patients with significant coronary artery disease and in 16 of 57 patients without. There were no differences between normotensive and hypertensive patients in sensitivity (77% (95% confidence interval (CI) 69% to 86%) v 75% (95% CI 68% to 83%)), specificity (74% (95% CI 60% to 89%) v 72% (95% CI 60% to 84%)), and accuracy (77% (95% CI 70% to 84%) v 74% (95% CI 68% to 80%)) of exercise SPECT for diagnosing coronary artery disease. The accuracy of SPECT was greater than electrocardiography, both in hypertensive patients (p = 0.005) and in normotensive patients (p = 0.0001). For the detection of coronary artery disease in individual vessels, sensitivity was 58% (95% CI 51% to 65%) v 57% (95% CI 51% to 64%), specificity was 86% (95% CI 82% to 90%) v 85% (95% CI 81% to 89%), and accuracy was 74% (95% CI 70% to 78%) v 74% (95% CI 70% to 78%) in patients with and without hypertension (NS).
CONCLUSIONS—In the usual clinical setting, the value of exercise myocardial perfusion scintigraphy for diagnosing coronary artery disease is not degraded by the presence of hypertension.


Keywords: hypertension; coronary artery disease; exercise stress test; myocardial perfusion     

腺苷负荷试验心肌核素显像对冠心病诊断价值的评估

目的分析腺苷负荷试验心肌核素显像对于冠心病诊断的敏感性、特异性及其特点。方法住院患者同时行冠状动脉（冠脉）造影和腺苷负荷试验心肌核素显像。腺苷总量为840μg／kg,6min匀速静脉泵入,腺苷泵入3min时静脉推注^99m锝-甲氧基异丁基异腈核素显像925MBq,1．5h后进行心肌断层显像,若异常,次日行静息心肌显像。结果冠脉造影阳性50例中,心肌核素显像阳性44例。29例冠脉造影无明显狭窄,其中19例心肌核素显像阴性。腺苷负荷试验心肌核素显像对于冠心病诊断的敏感性和特异性为88．O％和65．5％。前降支病变40例,心肌核素前壁区域低灌注32例,回旋支病变27例,侧壁区域低灌注21例,右冠脉病变32例,下壁区域低灌注31例,右冠脉病变较前降支或回旋支病变的心肌核素显像阳性率高（P〈0．05）。结论腺苷负荷试验心肌核素显像对于冠心病诊断的敏感性、特异性较高。     

药物负荷核素心肌灌注显影对冠心病的诊断价值

目的探讨药物负荷核素心肌灌注显像（MPI）对冠心病的诊断价值。方法回顾性分析88例疑有冠心病且同时行冠状动脉造影（CAG）和双嘧达莫或腺苷药物负荷核素MPI患者,CAG与MPI检查日期相差不超过14 d,以CAG检查结果作为诊断冠心病的金标准,对比分析药物负荷核素MPI敏感度、特异性等指标。结果药物负荷核素MPI诊断冠心病的敏感度、特异性、准确率分别为91.4%、73.3%、85.2%;在5例假阴性患者中,4例为单支病变,1例为双支病变,侧支循环均良好;8例假阳性患者中,3例为X综合征,4例为冠状动脉血流缓慢。结论药物负荷核素心肌灌注显像是无创诊断冠心病及心肌缺血的有效途径,其假阳性和假阴性患者多有相应的冠状动脉或心肌的病理生理基础。