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运动负荷核素心肌显像应用广泛,可准确评价受损心肌的位置、范围和严重程度,为患者选择合适的治疗方案提供依据,对不能耐受运动的特殊人群,药物负荷核素心肌显像是一种有效的替代方法,并可提高诊断准确性核素心肌显像,在现代冠心病的诊断处理中它有着十分重要的作用和地位。 相似文献
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目的:评价硝酸甘油介入99^mTc-MIBI心肌灌注显像(SPECT)诊断冠心病及估测心肌存活性的价值。方法:48例可疑冠心痛患者,于冠状动脉造影(CAG)术前1周内行静息、硝酸甘油介入99^mTc-MIBI心肌SPECT检查,以CAG为金标准,观察硝酸甘油介入99^mTc-MIBI心肌SPECT诊断冠心病的准确性。对于25例成功行经皮冠脉介入治疗(PCI)的冠心病患者,以PCI术后3个月室壁运动改善为检验标准,评价硝酸甘油介入99^mTc-MIBI心肌SPECT检测存活心肌的应用价值。结果:硝酸甘油介入99^mTc-MIBI心肌SPECT诊断冠心病的敏感性、特异性、准确性分别为83.9%、76.5%、81.3%,评价存活心肌的敏感性为91.8%,准确性为84.9%。结论:硝酸甘油介入99^mTc-MIBI心肌SPECT在诊断冠心痛及估测心肌存活性有较高的临床应用价值。 相似文献
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硝酸甘油介入99mTc-MIBI心肌灌注显像诊断冠心病及估测心肌存活性的价值 总被引:1,自引:0,他引:1
目的:评价硝酸甘油介入99mTc-MIBI心肌灌注显像(SPECT)诊断冠心病及估测心肌存活性的价值.方法:48例可疑冠心病患者,于冠状动脉造影(CAG)术前1周内行静息、硝酸甘油介入99mTc-MIBI心肌SPECT检查,以CAG为金标准,观察硝酸甘油介入99mTc-MIBI心肌SPECT诊断冠心病的准确性.对于25例成功行经皮冠脉介入治疗(PCI)的冠心病患者,以PCI术后3个月室壁运动改善为检验标准,评价硝酸甘油介入99Tc-MIBI心肌SPECT检测存活心肌的应用价值.结果:硝酸甘油介入99mTc-MIBI心肌SPECT诊断冠心病的敏感性、特异性、准确性分别为83.9%、76.5%、81.3%,评价存活心肌的敏感性为91.8%,准确性为84.9%.结论:硝酸甘油介入99mTc-MIBI心肌SPECT在诊断冠心病及估测心肌存活性有较高的临床应用价值. 相似文献
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运动负荷核素心肌显像应用广泛,可准确评价受损心肌的位置、范围和严重程度,为患者选择合适的治疗方案提供依据,对不能耐受运动的特殊人群,药物负荷核素心肌显像是一种有效的替代方法,并可提高诊断准确性核素心肌显像,在现代冠心病的诊断处理中它有着十分重要的作用和地位[1].本研究探讨SPECT 99mTc-MIBI 静息及腺苷负荷状态心肌灌注显像在评价绝经后女性冠心病诊断中的临床应用.…… 相似文献
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目的 探讨三磷酸腺苷介入心肌灌注断层显像(ATP-MPI)诊断老年人冠心病(CAD)的价值和安全性。方法49例无心肌梗死病史的老年冠心病待查患者(年龄≥60岁,平均年龄66.33岁)行ATP-MPI和冠状动脉造影(CAG)。结果ATP介入试验过程中,共有19种不良反应表现,但这些表现均在停止注射ATP后2分内自行终止,无一例病人因不良反应中断ATP介入试验。ATP-MPI诊断老年人冠心病的敏感性90.0%,特异性89.5%,准确性89.8%;诊断冠状动脉狭窄的敏感性84.1%,特异性90.1%。结论ATP介入心肌灌注断层显像是诊断老年冠心病准确性和安全性均很高的无创检查方法。 相似文献
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目的比较冠状动脉造影与门控心肌灌注显像诊断急性心肌梗死的临床价值。方法20例急性心肌梗死患者在2周内分别行门控心肌灌注断层显像、冠状动脉造影及其他影像检查,分别将冠状动脉造影结果、门控心肌灌注图像及室壁增厚率分级(各4级)进行比较。结果门控心肌灌注图像、左室室壁增厚率均与冠状动脉造影分级结果间有较好的相关性,左室室壁增厚率与心肌灌注图像分级结果间有较好的相关性。结论门控心肌灌注显像可提供心肌灌注图像、左室功能及左室运动参数,可作为冠状动脉造影前的可靠筛查手段。 相似文献
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SPECT心肌灌注显像在诊断冠心病方面的应用 总被引:1,自引:0,他引:1
我院自1992年10月引进SPECT以来已进行200余例心肌灌注显像,现将其中临床诊断为冠心病的129例病人作一总结如下。 1 资料和方法 1.1 临床资料:正常人10例,男女各5人,年龄30~65岁,平均46.6岁,既往无冠心病史,ECG、超声心动图检查均为正常;129例病人,由心内科医师最后诊断为冠心病(包括心绞痛116例和心肌梗塞13例),其中男107人,女22人,年龄20~77岁,平均为55.1岁,其中超声心动图检查79人,心电图检查114人。 1.2 检查方法:先对由北京阜外医院提供的心肌模型(前壁及间壁各有一矩形模拟梗塞灶的有机玻璃块)进行模拟断层检查,在心肌腔内注入~(99m)TcO7.4MBq(2mci),置于断层床上模拟人体仰卧位时心脏位置,用SOPHA MEDICAL DS7型SPECT 相似文献
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目的探讨心肌血流储备分数(FFR)和核素心肌灌注显像(MPI)诊断冠状动脉临界病变患者心肌缺血的一致性,并分析FFR处于灰色区域(FFR为0. 75~0. 80)且MPI正常组和FFR 0. 80组患者未行经皮冠状动脉介入治疗(PCI)的远期预后。方法回顾性分析30例行冠状动脉造影(CAG)和FFR检测的冠状动脉临界病变患者的病例资料,患者CAG术前2周内均行MPI。分别以FFR 0. 75和FFR 0. 80为心肌缺血的判断标准,分析MPI和FFR的一致性,绘制MPI的差异总积分(SDS)诊断心肌缺血的受试者工作特征曲线(ROC)。将CAG术中未行PCI的22例患者分别纳入指导组(FFR为0. 75~0. 80且MPI正常,7例)和对照组(FFR 0. 80,15例),术后随访51~82个月,平均(65. 7±8. 8)个月,观察2组心源性死亡、心肌梗死、再次血运重建等主要不良心脏事件(MACE)和再发心绞痛的发生率。结果 FFR 0. 75时,MPI和FFR的一致性一般(Kappa=0. 536),MPI诊断临界病变心肌缺血的灵敏性、特异性、准确性、阴性预测值、阳性预测值分别为80. 0%、87. 1%、86. 1%、96. 4%和50. 0%。FFR 0. 80时,MPI和FFR的一致性较差(Kappa=0. 204),MPI诊断的灵敏性、特异性、准确性、阴性预测值、阳性预测值分别为33. 3%、85. 7%、63. 9%、64. 3%和62. 5%。指导组和对照组患者术后均未发生MACE事件,术后分别再发心绞痛2次(28. 6%)和4次(26. 7%)。结论 FFR 0. 75时,MPI与FFR诊断冠脉临界病变心肌缺血的一致性更好。MPI对于FFR处于灰色区域冠状动脉临界病变患者具有一定辅助诊断价值。 相似文献
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门控心肌灌注显像诊断冠心病的临床价值 总被引:2,自引:0,他引:2
目的:探讨腺苷负荷99mTc-MIBI门控心肌灌注显像(G-MPI)后室壁运动和增厚率异常对冠心病的诊断价值。方法:对91例确诊或临床疑诊为冠心病患者行静息-腺苷负荷99mTc-MIBI G-MPI和非门控心肌灌注显像(MPI),两周内行冠状动脉造影(CAG),对其结果进行对比分析。结果:MPI诊断冠心病的灵敏度为85.3%,特异性为73.9%,G-MPI诊断冠心病灵敏度为92.6%,特异性为87.0%,结合腺苷负荷后局部室壁运动和增厚率评分可提高G-MPI诊断冠心病的灵敏度和特异性。结论:静息-腺苷负荷99mTc-MIBI G-MPI对冠心病的诊断有较高的灵敏度和特异性。 相似文献
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【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。 相似文献
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目的:了解核素心肌灌注显像(radionuclide myocardial perfusion imaging,MPT)对冠状动脉造影阴性的女性胸痛患者的临床评估价值。方法入选因胸痛就诊于我院并行冠状动脉造影检查阴性的女性患者55例,根据MPT 检查结果,分为 MPT 阳性组及 MPT 阴性组,对两组患者的运动试验、血脂指标及高血压病、糖尿病、高血脂等合并症进行比较。结果55例患者中 MPT 阳性组24例(43.6%),MPT 阴性组31例(56.4%);MPT 阳性组运动试验阳性率显著高于 MPT 阴性组(P <0.05);两组患者年龄、高血压、高血脂、糖尿病等合并症差异无统计学意义,血清各血脂指标差异亦无统计学意义(P >0.05),而外周动脉粥样硬化在 MPT 阳性组明显高于 MPT 阴性组(P <0.05)。结论女性胸痛患者仅以冠状动脉造影正常而诊断正常误诊率较高,对运动试验阳性、合并外周动脉粥样硬化的患者应行核素心肌灌注检查。 相似文献
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门控心肌显像评价冠心病左心室舒张末期瞬间缺血扩张的价值 总被引:2,自引:0,他引:2
目的:探讨左心室舒张末期瞬间扩张比(TID)与血管狭窄程度和累及范围关系。方法:收集2004年5月至2006年12月在我院行99mTc-MIBI心肌灌注运动和负荷检查的患者183例,按冠状动脉造影结果所示的血管狭窄程度和累及范围及核素灌注显像的缺血程度分类,比较不同程度的狭窄和缺血TID值。结果:在无狭窄组和无缺血组的TID值分布为0.9~1.1,狭窄组和缺血组TID值随累及范围扩大和严重程度加重而增加,但在轻度缺血及狭窄组与正常组的比较中未见明显统计学差异,而狭窄程度大于70%或心肌灌注呈不可逆的缺血组TID值均有显著改变。结论:门控心肌灌注显像的TID计算可反映心功能状况,对评估心肌缺血造成的心功能损害具一定参考意义。 相似文献
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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。 相似文献
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腺苷负荷心肌灌注显像与双源CT冠状动脉造影诊断冠心病 总被引:3,自引:3,他引:0
目的 探讨腺苷(ADE)负荷门控心肌灌注显像(G-MPI)与双源CT冠状动脉造影(DSCTCA)诊断冠状动脉病(CAD)的价值。方法 选择CAD可能性为低、中、高度的患者共53例,采用两日法行静息、腺苷负荷锝标记甲氧基异丁基异腈(99mTc-MIBI)G-MPI及DSCTCA,并于4周内进行CAG。采用美国心脏病协会17节段5分制(0~4分)目测半定量方法对MPI结果进行分析,静息与负荷评分的差值>1为可逆性缺血。DSCTCA结果采用目测直径法判断冠状动脉狭窄程度,分为:正常、狭窄<50%及狭窄程度≥50%。以CAG结果为"金标准",狭窄程度≥50%时定义为CAD,比较MPI和DSCTCA对CAD的诊断价值及两者之间的关系。结果 G-MPI和DSCTCA对CAD的诊断敏感度、特异度及准确率分别为94.44%(34/36)、52.94%(9/17)、81.13%(43/53)及88.89%(32/36)、88.24%(15/17)、88.68%(47/53)。两种检查方法差异有统计学意义(χ2=9.28,P=0.005)。结论 G-MPI和DSCTCA诊断CAD均有较高价值,联合应用可提供功能及解剖两方面的信息,提高对CAD的诊断效能。 相似文献
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目的 评价PET/CT心肌灌注显像(MPI)联合冠状动脉CTA(CTCA)诊断冠心病的准确性。方法 检索2001-2011年有关PET/CTCA诊断冠心病的原始研究,经过质量评价后对符合纳入标准的文献进行数据提取,并行Meta分析和亚组分析,绘制森林图和拟合ROC曲线。结果 纳入6篇文献(252例),按照随机效应模型合并后,MPI/CTCA、单独MPI和单独CTCA(段)的诊断敏感度(SEN)、特异度(SPE)、阳性预测值(PPV)、阴性预测值(NPV)、诊断比值比(DOR)、诊断准确率(ACC)及曲线下面积(AUC)分别为0.91(95%CI 0.84~0.96)、0.91(95%CI 0.84~0.96)和0.87(95%CI 0.80~0.92),0.99(95%CI 0.96~1.00)、0.91(95%CI 0.84~0.96)和0.91(95%CI 0.88~0.94),0.95(95%CI 0.82~1.00)、0.94(0.86~1.00)和0.85(0.59~0.92),0.93(0.88~0.99)、0.84(0.78~0.97)和0.91(0.69~1.00),381.23(95%CI 98.04~1482.48)、113.20(95%CI 36.39~352.19)和73.59(95%CI 35.70~151.69),0.9671、0.9638和0.9575。结论 MPI/CTCA较单独MPI或单独CTCA无绝对优势,但鉴别冠状动脉痉挛所致MPI假阳性与代偿期冠状动脉狭窄所致MPI假阴性优势互补。 相似文献
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Gudmundsson P Winter R Dencker M Kitlinski M Thorsson O Ljunggren L Willenheimer R 《Clinical physiology and functional imaging》2006,26(1):32-38
BACKGROUND: Real-time perfusion (RTP) contrast echocardiography using low mechanical index power modulation technique allows for simultaneous myocardial perfusion and wall motion analysis. RTP-adenosine stress echocardiography (ASE) could be an alternative to dobutamine-atropine stress echocardiography; more tolerable for the patients and possibly similarly accurate. We aimed to evaluate RTP-ASE for the detection of myocardial ischaemia, compared to 99mTc-sestamibi single-photon emission computed tomography (SPECT). METHODS: Patients with suspected coronary artery disease, admitted to SPECT evaluation, were prospectively invited to participate. Patients underwent RTP imaging (SONOS 5500) using infusion of Sonovue (Bracco, Milano, Italy) before and during ASE. Two separate readers performed off-line analysis of myocardial perfusion and wall motion by RTP-ASE. A perfusion defect was the principal marker of ischaemia. Wall motion assessment was used to evaluate ischaemia in segments with perfusion artefacts. Each segment was attributed to one of the three main coronary vessel areas of interest: the left anterior descending (LAD); the left circumflex (LCx) and the right posterior descending (RPD). Normal SPECT at stress was judged normal at rest. RESULTS: In 33 patients, 99 coronary territories were analysed by SPECT and RTP-ASE. SPECT showed evidence of ischaemia in 9 of 33 patients. For the detection of ischaemia, the overall level of agreement between RTP-ASE and SPECT was 92% in all segments. The level of agreement was 88% in LAD, 97% in LCx and 91% in RPD segments. CONCLUSION: Real-time perfusion-adenosine stress echocardiography using power modulation could be an accurate and feasible tool for evaluation of ischaemia in patients with suspected coronary artery disease. The results from this study need confirmation by a study of a larger patient sample. 相似文献
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Haramati LB Levsky JM Jain VR Altman EJ Spindola-Franco H Bobra S Doddamani S Travin MI 《The international journal of cardiovascular imaging》2009,25(3):303-313
To evaluate the utility of CT coronary angiography (CTA) for demonstrating coronary artery disease in inner-city outpatients,
we prospectively compared CTA with stress SPECT myocardial perfusion imaging in an ethnically diverse, gender balanced population.
All patients gave written informed consent for this IRB approved, HIPAA compliant study. Sixty-one patients completed both
CTA and SPECT. About 67% were ethnic minorities, 51% were women. A stenosis of ≥70% on CTA was considered positive. Results
were compared with perfusion defects on SPECT and correlated with clinical endpoints (hospital admissions, cardiovascular
events, coronary interventions and deaths). CTA and SPECT data were compared with results of coronary angiography, when performed.
There was moderate global agreement of 79% (48/61) between CTA and SPECT, κ = 0.483 (SE ± 0.13, P = 0.0001). With SPECT as the reference standard, CTA had sensitivity of 73% (11/15), specificity of 80% (37/46), negative
predictive value of 90% (37/41) and positive predictive value of 55% (11/20). Positive SPECT was associated with positive
CTA, (P < 0.0001, OR = 22). Eleven (18%) underwent subsequent cardiac catheterization, which was positive in 91% (10/11). CTA and
SPECT had positive predictive values of 90 and 83% compared with catheterization. This study lends preliminary evidence to
support to the utility of CTA as an alternative modality for the evaluation of CAD in an ethnically diverse, gender balanced
inner-city outpatient population. Similar to more homogenous groups, CTA had a high negative predictive value and demonstrated
disease occult to SPECT. Further study is necessary to evaluate the impact of CTA on patient outcomes. 相似文献
20.
Kim DW Park SA Kim CG Lee C Oh SK Jeong JW 《The international journal of cardiovascular imaging》2008,24(5):503-510
Purpose If coronary artery was treated with optimal stent implantation, myocardial perfusion in the territory supplied by a dilated
coronary artery should be not reversible. However, several studies have demonstrated reversible perfusion in the territory
supplied by a coronary artery with an optimally implanted stent. The main objective of this study was to evaluate the incidence
of reversible defects detected by M-SPECT early after optimal PTCA with stent implantation. Its second objective was to determine
the predictive value of detecting reversible defects after stent implantation for late restenosis. Methods About 66 patients that underwent M-SPECT within 24 h of successful PTCA with stent implantation were included. All patients
were followed up clinically and angiographically. The incidence of reversible perfusion defects on M-SPECT and the rate of
late restenosis in target coronary arteries were evaluated retrospectively. Results Reversible perfusion defects on M-SPECT were observed in 26% of the patients and in 36% of lesions following successful PTCA
with stent implantation. The incidence of late restenosis was significantly higher in patients and lesions with reversible
perfusion defects (47% vs. 18%). According to binary logistic regression analysis, the presence of a reversible perfusion
defects was the only independent predictor of late restenosis. 相似文献