磁共振心肌灌注延迟增强与核素心肌灌注/代谢显像识别存活心肌对比研究

目的应用磁共振成像心肌灌注延迟显像(DE-MRI)所显示的高信号识别存活心肌和瘢痕组织,通过与99Tcm-甲氧基异丁基异腈(MIBI)单光子发射型计算机断层(SPECT)和18F-脱氧葡萄糖(FDG)SPECT进行对比研究,评估其诊断的敏感性和特异性,并分析两种方法的一致性。方法34例临床确诊的心肌梗死患者,拟行再血管化手术治疗。男性29例,女性5例,年龄(58.0±9.8)岁,接受心脏MRI及SPECT灌注/代谢显像检查。两种方法各划分5个等级,依据17节段分析法,分析34例患者共578个节段,并对两种评价心肌存活的方法行一致性分析。结果DE-MRI判断存活心肌431段(74.6%),坏死心肌147段(25.4%)。SPECT灌注/代谢显像诊断正常心肌336段(58.1%),坏死心肌212段(36.7%),缺血心肌30段(5.2%)。两种方法半定量分析显示一致性较好,Kappa值为0.51(>0.4)。以节段为单位,DE-MRI的敏感性为61.3%,特异性为95.4%。结论DE-MRI能够有效地识别存活心肌和瘢痕组织,并与18F-FDGSPECT一致性较好。     

负荷磁共振心肌灌注成像在冠心病中的应用

近年来,负荷磁共振（MR）心肌灌注成像已经成为一个可以准确诊断冠心病并提供大量预后信息的非侵入性检查技术。它具有早期准确的发现冠状动脉病变、观察局部和整体的心功能、高空间分辨率、没有电离辐射等优势。本文对负荷MR心肌灌注成像在诊断冠心病中的应用做一综述。     

实时心肌超声造影与心脏磁共振成像心肌灌注延迟显像评价急性心肌梗死微循环的对比分析

目的 研究实时心肌超声造影(real-time myocardial contrast echocardiography,RT-MCE)与心脏磁共振成像心肌灌注延迟显像(delayed enhancement-magnetic resonance imaging,DE-MRI)在急性心肌梗死(acute myo-car...     

核素心肌灌注显像在冠心病中的应用进展

多年来核素心肌灌注显像一直是全世界,尤其是美国最常用的冠心病诊断处理技术。现回顾并评价核素心肌灌注显像在冠心病诊断、危险度分层和预后评估,以及临床治疗决策中的价值。同时,联合冠状动脉钙化积分、螺旋CT冠状动脉造影及正电子发射体层摄影等其它无创检查将有助于冠心病的早期诊断、治疗决策和血运重建术的合理选择,减少冠心病患者总体医疗费用。     

核素心肌灌注显像与电子束CT诊断冠心病的对比研究

目的 :比较核素心肌灌注显像 (SPECT)与电子束 CT(EBCT)冠状动脉钙化定量积分对冠心病 (CHD)的诊断价值。方法 :44例住院患者同时进行冠状动脉造影 (CAG)、SPECT和EBCT检查。以 CAG为金标准 ,比较 SPECT与 EBCT诊断 CHD的各项诊断指标 ,并评价平行试验和系列试验的诊断指标。结果 :SPECT诊断 CHD的敏感性为 88.9% ,特异性为 69.2 % ,准确性为 77.3% ;EBCT以钙化积分≥ 1 0分为阳性标准 ,敏感性、特异性、准确性分别为 77.8%、80 .8%及 79.5%。这两种方法对检测 CHD的价值相似 (P >0 .0 5)。 SPECT与 EBCT联合平行试验的准确性为 72 .7% ;系列试验的准确性为 86.4%。结论 :SPECT与 EBCT诊断 CHD的效率相近 ;SPECT显像和 EBCT冠状动脉钙化定量积分法均为非创伤性检查法 ,对 CHD的诊断各有优势 ,宜结合使用     

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。     

核素心肌灌注显像对冠心病诊断及治疗效果的评价

为评价核素心肌灌注显像对冠心病诊断的价值,并用其判断血运重建术的疗效,对 ７２ 例冠心病或可疑冠心病患者行冠脉造影术与核素心肌灌注显像,并对其中１５ 例患者在血运重建术后复查心肌灌注显像。结果表明核素心肌显像诊断冠心病的灵敏度与特异性分别为９５％ 与 ８６％ ;血运重建术后平均缺血节段数无明显改变,平均缺血分数显著降低。结论:①核素心肌显像对冠心病诊断的灵敏度与特异性均很高;②血运重建术后,原缺血心肌供血明显改善。     

腺苷负荷心肌灌注显像在冠心病诊断中的应用

目的:评价腺苷负荷心肌灌注显像试验对冠心病的诊断价值。方法:60例住院患者均行腺苷负荷心肌灌注显像和冠状动脉造影(CAG),腺苷以0.14mg/(kg.min)的速度外周静脉输入,第3分钟时,静脉注射放射性核素99mTc-MIBI740MBq,1.5h后进行心肌断层显像,若异常,次日行静息心肌显像,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。结果:CAG阳性42例中,心肌核素显像阳性37例(敏感性88%)。18例CAG无明显狭窄,其中13例心肌核素显像阴性(特异性为72%)。前降支病变36例,心肌核素前壁区域低灌注20例,回旋支病变22例,侧壁区域低灌注14例,右冠脉病变28例,下壁区域低灌注27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(P0.05)。在应用过程中,腺苷未出现明显不良反应。结论:腺苷负荷试验心肌核素灌注显像对于冠心病诊断的敏感性、特异性较高,对诊断冠心病具有重要意义。     

腺苷心肌灌注断层显像诊断老年人冠心病的价值

目的 探讨腺苷负荷试验锝-甲氧基异丁基异腈(~(99m)Tc-MIBI)心肌灌注单光子发射计算机断层显像(ECT)诊断老年人冠心病的价值. 方法 53例无心肌梗死病史的老年冠心病待查患者,年龄60～78岁,平均(65.5±6.5)岁.将ECT和冠状动脉造影(CAG)结果进行对照. 结果 ECT对CAG阳性冠心病诊断的敏感性为73.7%,特异性90.9%,阳性预测值为94.3%,阴性预测值为80.0%,准确性指数为62.3%.结果显示,腺苷ECT对左前降支、回旋支、右冠状动脉检出的特异性分别为90.9%、85.7%、100%,阳性预测值分别为73.5%、77.3%、72.0%. 结论 腺苷是一种较强的血管扩张剂,对心血管系统有多重作用.其与导管技术、核素心肌灌注显像等技术结合可用于冠心病的诊断.腺苷介入心肌灌注断层显像是一种无创、方便、费用低的检查方法,对老年冠心病的诊断、指导治疗和判断预后有重要的意义.     

负荷与静息门控核素心肌灌注显像左心室不同步参数的差异性研究

目的 比较负荷与静息门控核素心肌灌注SPECT显像(G-MPS)相位分析技术(SyncTool)所测定的左心室不同步参数之间是否存在差异.方法 回顾性入选行负荷/静息G-MPS的正常对照组患者60例、心肌缺血组患者40例和心功能不全组患者40例,各有一半接受运动或腺苷负荷G-MPS.应用SyncTool对负荷/静息G-MPS短轴图像进行相位分析,计算出左室不同步参数相位标准差(PSD)和相位直方图带宽(PHB).结果 各组患者运动负荷与静息G-MPS的左心室不同步参数(PSD、PHB)均无明显差异(P＞0.05),腺苷负荷与静息G-MPS的上述参数也均无明显差异(P＞0.05).将心功能不全组分为缺血性心肌病与扩张型心肌病两个亚组,各亚组负荷与静息G-MPS的左心室不同步参数(PSD、PHB)均无明显差异(P＞0.05).结论 负荷试验(运动或腺苷)后1小时采集的99Tcm-sestamibi G-MPS所获得的PSD和PHB与静息G-MPS所获得的上述参数无显著差异,常规负荷G-MPS可以用于左心室同步性分析.     

Myocardial contrast echocardiography for the detection of coronary artery stenosis: a prospective multicenter study in comparison with single-photon emission computed tomography.

OBJECTIVES: The purpose of this study was to compare myocardial contrast echocardiography (MCE) with single-photon emission computed tomography (SPECT) for the detection of significant coronary artery disease (CAD) in patients with symptoms suggestive of CAD. BACKGROUND: Single-photon emission computed tomography is a well-established method of assessing patients with CAD. Myocardial contrast echocardiography is a new technique allowing bedside assessment of myocardial perfusion. We hypothesized that MCE was comparable to SPECT in the assessment of patients with known or suspected CAD. METHODS: A total of 123 patients scheduled for coronary angiography underwent intermediate (mechanical index 0.5) triggered replenishment MCE and SPECT imaging at rest and after vasodilator stress. Coronary angiography was performed within four weeks of stress imaging. RESULTS: In total, 96 of 123 (78%) patients demonstrated CAD (stenosis >/=50%). There was no difference in the sensitivity of MCE compared with SPECT in the detection of CAD (84% vs. 82%; p = NS), and both demonstrated similar specificity (56% vs. 52%, respectively). In patients with multivessel disease, MCE and SPECT also demonstrated similar sensitivity (91% and 88%, respectively) for the detection of CAD. Agreement between MCE and SPECT for the presence or absence of CAD was 73%. CONCLUSIONS: Myocardial contrast echocardiography is comparable to SPECT in the detection of CAD not only on a patient basis but also in the localization of disease by vascular territory in a relatively high-risk population.     

MR-IMPACT: comparison of perfusion-cardiac magnetic resonance with single-photon emission computed tomography for the detection of coronary artery disease in a multicentre, multivendor, randomized trial.

AIMS: To determine in a multicentre, multivendor trial the diagnostic performance for perfusion-cardiac magnetic resonance (perfusion-CMR) in comparison with coronary X-ray angiography (CXA) and single-photon emission computed tomography (SPECT). METHODS AND RESULTS: Of 241 eligible patients from 18 centres, 234 were randomly dosed with 0.01, 0.025, 0.05, 0.075, or 0.1 mmol/kg Gd-DTPA-BMA (Omniscantrade mark, GE-Healthcare) per stress (0.42 mg/kg adenosine) and rest perfusion study. Coronary artery disease (CAD) was defined as diameter stenosis > or =50% on quantitative CXA. Five CMR and eight SPECT studies (of 225 complete studies) were excluded from analyses due to inadequate quality (three blinded readers scored per modality). The comparison of CMR vs. SPECT was based on receiver operating characteristic (ROC) analysis. Perfusion-CMR at the optimal CM dose (0.1 mmol/kg) had similar performance as SPECT, if only the SPECT studies of the 42 patients with this dose were considered [area under ROC curve (AUC): 0.86 +/- 0.06 vs. 0.75 +/- 0.09 for SPECT, P = 0.12]; however, diagnostic performance of perfusion-CMR was better vs. the entire SPECT population (AUC: 0.67 +/- 0.05, n = 212, P = 0.013). CONCLUSIONS: In this multicentre, multivendor trial, ROC analyses suggest perfusion-CMR as a valuable alternative to SPECT for CAD detection showing equal performance in the head-to-head comparison. Comparing perfusion-CMR with the entire SPECT population suggests CMR superiority over SPECT, which warrants further evaluation in larger trials.     

Comparison of planar imaging and single-photon emission computed tomography for the detection and localization of coronary artery disease

Although single photon emission computed tomography (SPECT) has become widely utilized, the superiority of this technique compared to planar conventional imaging remains controversial. In order to compare these two techniques, we retrospectively analysed the results obtained in 70 patients who performed a thallium-201 exercise scintigraphy with a double acquisition during the same test, and who also underwent coronary and ventricular angiography. Overall, SPECT imaging yielded a higher sensitivity (93% vs 82% for SPECT and planar imaging respectively, p<0.05), especially in the inferior and anterior regions. SPECT was also more sensitive for the detection of a single-vessel disease (90% vs 74% for SPECT and planar imaging respectively, p<0.01). The specificity was assessed for both techniques with the help of circumferential computerized analysis, avoiding known causes of false positive scintigrams. We found a high specificity for both SPECT and planar imaging, without any significant difference between the two methods (87% vs 91% for the overall specificity of SPECT and planar imaging respectively, p=NS). Therefore, SPECT imaging analysed with discrimination shows an enhanced reliability over planar imaging for the detection and the localization of coronary artery disease, without increasing the risk of false positive tests.     

Stress scintigraphy using single-photon emission computed tomography in the evaluation of coronary artery disease

Twenty-seven patients with angina pectoris, 24 with postmyocardial infarction angina and 7 with normal coronary arteries were examined by exercise thallium-201 emission computed tomography (SPECT) and planar scintigraphy. Exercise SPECT was compared with the reperfusion imaging obtained approximately 2 to 3 hours after exercise. The sensitivity and specificity of demonstrating involved coronary arteries by identifying the locations of myocardial perfusion defects were 96 and 87% for right coronary artery, 88 and 89% for left anterior descending artery (LAD) and 78 and 100% for left circumflex artery (LC). These figures are higher than those for planar scintigraphy (85 and 87% for right coronary artery, 73 and 89% for LAD and 39 and 100% for LC arteries). In patients with 3-vessel disease, sensitivity of SPECT (100, 88 and 75% for right coronary artery, LAD and LC, respectively) was higher than planar imaging (88, 63 and 31%, respectively), with a significant difference for LC (p less than 0.05). In 1, 2 and 0-vessel disease the sensitivity and specificity of the 2 techniques were comparable. Multivessel disease was more easily identified as multiple coronary involvement than planar imaging with a significant difference in 3-vessel disease (p less than 0.05). In conclusion, stress SPECT provides useful information for the identification of LC lesions in coronary heart disease, including 3-vessel involvement.     

Cardiac magnetic resonance myocardial perfusion imaging for detection of functionally significant obstructive coronary artery disease: A prospective study

Background

Cardiac magnetic resonance myocardial perfusion imaging (CMR-MPI) is considered a state of the art non-invasive modality for the detection of reversible ischemia. Recent studies have shown its utility in the diagnosis of coronary artery disease (CAD) and superiority over other established techniques. However, only a few studies compared CMR-MPI against the invasive standard including fractional flow reserve (FFR) and clinical validation in non-specialized centers is scarce. The aim of this study was to validate CMR-MPI in a real-world clinical environment and to test its diagnostic accuracy in symptomatic patients with suspected CAD versus FFR as the reference standard of functionally significant disease.

Methods and results

103 symptomatic consecutive patients (62 ± 8.0 years, 66% males) with suspected CAD and intermediate or high probability of disease underwent sequential CMR and invasive coronary angiography (XA). The CMR protocol included stress-rest adenosine perfusion, SSFP cine imaging and late-enhancement imaging. Functionally significant CAD was defined as occlusive/sub-occlusive stenoses on XA or non-occlusive stenoses with a FFR measurement of < 0.80 in vessels > 2 mm. On a patient-based model, CMR-MPI had sensitivity, specificity, positive and negative predictive values of 89%, 88%, 85%, and 91%, respectively, with a global accuracy of 88%. On a vessel-based analysis, these values were 80%, 93%, 79% and 94%, respectively, with a global accuracy of 90%.

Conclusions

CMR-MPI had a very high accuracy for detection of functionally significant CAD as assessed by FFR in patients with intermediate to high pretest probability.     

Usefulness of cardiac magnetic resonance imaging for coronary artery disease detection

Cardiac magnetic resonance imaging (cMRI) is a promising non-invasive technique to assess the presence of coronary artery disease (CAD), which is free of ionizing radiation and iodine contrast. cMRI can detect CAD by angiographic methods or indirectly by perfusion stress techniques. While coronary angiography by cMRI remains limited to research protocols, stress perfusion cMRI is currently being applied worldwide in the clinical setting. Studies have shown good correlation between adenosine-induced stress myocardial perfusion cMRI and single-photon-emission computed tomography or positron emission tomography to detect CAD. Quantitative methods to analyze cMRI perfusion data have been developed in an attempt to provide a more objective imaging interpretation. Standardization of such quantitative methods, with minimal operator dependency, would be useful for clinical and research applications. Myocardial perfusion reserve (MPR), calculated using Fermi deconvolution technique, has been compared with well established anatomical and physiological CAD detection techniques. MPR appears to be the most accurate quantitative index to detect anatomical and hemodynamically significant CAD. Beyond physiological assessment of CAD, cMRI provides information regarding regional and global left ventricular function and morphology, myocardial infarction size, transmurality and viability. Such comprehensive information would require the performance of multiple tests if other modalities were used. This article describes current applications of cMRI for evaluation of patients with CAD.