超声二次谐波心肌声学造影与冠状动脉造影的对比分析

目的 :对比研究超声二次谐波心肌声学造影 (MCE)与冠状动脉造影 (CAG)对冠心病的诊断价值。方法 :静脉注射声学造影剂利声显 (levovist)进行超声二次谐波心肌声学造影 ,按冠脉支配区域将左心室 9段分法进行心肌灌注记分 ,分值与冠脉狭窄程度比较分析。结果 :当心肌灌注MCE分值为 0时 ,相应冠脉狭窄 >85 %的可能性为72 .4 % ,而MCE分值为 1时 ,相应冠脉狭窄 <85 %的可能性为 85 .9% ,冠脉狭窄各组之间MCE分值有显著差异 ,P值均 <0 .0 1～ 0 .0 0 1。结论 :MCE能较准确地反映心肌血流灌注 ,从而判断冠脉病变的程度和部位 ,可作为冠脉造影筛选、补充以及冠脉血运重建疗效判断的一个有效的方法     

心肌声学造影与冠状动脉造影的对比分析

目的:对比研究超声心肌声学造影(MCE)与冠状动脉造影(CAG)对冠心病的诊断价值。方法:静脉注射声学造影剂Brocco产的声诺维(Sonovue)进行超声二次谐波心肌声学显影,按ASE推荐左心室分析法,将左室壁分为16段进行心肌灌注记分,分值与冠状动脉狭窄程度比较分析。结果:MCE检出心肌灌注异常与冠状动脉狭窄≥50%的符合率为76%,当心肌灌注MCE分值为0时,相应冠状动脉狭窄>75%的可能性为80.8%,而MCE分值为1时,相应冠状动脉狭窄≤75%的可能性为81.8%,冠状动脉狭窄各组之间MCE分值差异有显著性,P值均<0.01～0.001。结论:MCE能较准确地反映心肌血流灌注,从而判断冠状动脉病变的程度和部位,可作为冠状动脉造影筛选的一个有效的方法。     

MCE 与2D-STI 评价不同冠状动脉狭窄程度患者的心肌灌注水平与收缩功能

目的： 应用心肌声学造影(myocardial contrast echocardiography,MCE) 与二维斑点追踪技术(twodimensional speckle tracking imaging,2D-STI)评价不同程度冠状动脉狭窄时心肌灌注水平与收缩功能的变化。方法： 选取25 例冠心病患者行MCE,2D-STI及冠状动脉造影检查,各患者心肌节段根据冠状动脉造影中冠状动脉狭窄情况 分为4 组：A组(正常冠状动脉)、B组(轻度狭窄50%~75%)、C组(中度狭窄76%~90%)及D组(重度狭窄91%~100%)。 经过MCE和2D-STI 软件采样及计算,记录每组心肌节段MCE定量指标血容量、血流速度、血流量及2D-STI 定量指 标心肌纵向应变值,并比较其差异。结果： B,C及D组定量指标血流速度、血流量逐渐减小,差异有统计学意义 (P<0.05),A组血容量、血流速度、血流量与B组无明显差异(P>0.05),4 组间心肌纵向应变值差异均有统计学意义 (P<0.05)。结论：MCE及2D-STI 可评价不同冠状动脉狭窄程度的心肌灌注水平与收缩功能,2D-STI 发现冠状动脉轻 度狭窄的能力较MCE更好。     

Comparison of 99mTc-methoxyisobutylisonitrile myocardial single-photon emission computed tomography and electron beam computed tomography for detecting coronary artery disease in patients with no myocardial infarction

Background Previous studies have compared single-photon emission computed tomography (SPECT) and electron beam computed tomography (EBCT) in detection of coronary artery disease (CAD) in patients with myocardial infarction (MI). The purpose of this study was to compare SPECT with EBCT in detection of CAD in patients with no MI.Methods One hundred and forty-seven patients with suspected CAD underwent stress-rest 99mTc-methoxyisobutylisonitrile (99mTc-MIBI) myocardial SPECT, cardiac EBCT and coronary angiography (CAG) within one month. Of them, 73 patients (aged 52.6±10.6 years old) with no history of MI were included in this study. Coronary artery calcium (CAC) was defined as a CT value ≥130 HU within the boundary of coronary artery on EBCT. Results There were 35 and 38 patients with or without CAD according to CAG. Ninety-six percent of the patients with abnormal SPECT and CAC had a coronary arteries stenosis ≥50%, and 90.9% patients with normal SPECT and EBCT showed no CAD. The sensitivity of SPECT and EBCT in detection of CAD was comparable, and the specificity of SPECT (92.1%) was significantly higher than that of EBCT (55.3%) (P&lt;0.005). For the detection of individual coronary artery stenosis, both sensitivity and specificity of SPECT (75.0% and 93.7%) were significantly higher than those of EBCT (53.3% and 76.7%) (P&lt;0.025 and P&lt;0.005, respectively). In patients without chest pain, the sensitivity and specificity of SPECT (76.9% and 91.4%) were significantly higher than those of EBCT (23.1% and 69.0%) in detection of a coronary artery stenosis of ≥50% (P&lt;0.01 and P&lt;0.005, respectively). However, in patients with chest pain, both sensitivity and specificity of SPECT were comparable to those of EBCT. In patients ≤45 years old, the sensitivity of SPECT (77.8%) was significantly higher than that of EBCT (27.8%) in assessing a coronary artery stenosis of ≥50% (P&lt;0.005), and the specificity of SPECT was comparable to that of EBCT. In patients &gt;45 years old, the specificity of SPECT (94.3%) was significantly higher than that of EBCT (70.5%) (P&lt;0.005), and the sensitivity of SPECT was comparable to that of EBCT. Conclusion 99mTc-MIBI myocardial perfusion SPECT has higher accuracy than that of EBCT in detection of CAD in patients without MI.     

SPECT心肌灌注显像和冠脉CTA对功能相关冠脉病变的诊断价值

目的分析单光子发射型计算机断层(SPECT)心肌灌注显像(MPI)和冠状动脉CT造影(CCTA)对功能相关冠脉病变(FRCAL)的诊断价值。方法收集我院心血管内科收治的85例疑诊冠心病(CAD)患者分别行CCTA和同机SPECT-MPI检查,根据CCTA结果判断冠脉狭窄程度,MPI图像采用17节段5分法分析,于CCTA/MPI融合影像上匹配出心肌血流灌注异常区域与供血冠脉病变情况,评估心肌灌注异常与供血冠脉狭窄程度的相关性。并于15日内行冠脉造影(CAG)诊治,分析CCTA/MPI融合影像诊断FRCAL的价值。结果本组患者中,心肌血流灌注正常7例,轻度、中度、重度灌注异常27例、37例、10例,无灌注4例;共发现灌注异常区87个,其平均血流灌注评分(2.56±0.80)分。87个心肌灌注异常区域中,有12个供血冠脉正常,剩余异常区域平均狭窄率为(66.78±10.25)%,心肌灌注异常越严重,其供血冠脉狭窄程度越高(P<0.05)。相关性分析显示心肌血流灌注评分与冠脉狭窄程度呈明显正相关(P<0.05)。CAG确诊存在FRCAL66例,以CAG为标准,CCTA/MPI融合影像诊断FRCAL的敏感度、特异度及准确率分别高达92.42%、84.21%、90.59%,明显高于二者单独诊断。结论心肌血流灌注异常与冠脉狭窄密切相关,CCTA/MPI融合影像可用于诊断FRCAL,继而可为CAD的精确诊断提供依据。     

Usefulness of dobutamine stress myocardial contrast echocardiography for assessing coronary artery disease

Background Quantitatively assessing myocardial perfusion and its reserve is of great importance for the diagnosis and stratification of patients with coronary artery disease (CAD), and represents an important goal of myocardial contrast echocardiography. In this study we sought to test the usefulness of low dose dobutamine stress real-time myocardial contrast echocardiography (RT-MCE) in the assessment of CAD, and to explore the relationship between perfusion reserve and contractile reserve.Methods Twenty-six patients with suspected or clinical diagnosed CAD were enrolled and underwent RT-MCE at baseline and under low dose dobutamine stress, and subsequent coronary angiography. RT-MCE images were analyzed quantitatively from microbubble replenishment curves for myocardial perfusion and its reserve. Results At baseline, significant differences in beta (0.28±0.12, 0.25±0.09, 0.22±0.06, 0.20±0.07 respectively, P＜0.01) and A×beta (1.37±0.46, 1.28±0.47, 1.13±0.37, 0.91±0.32, respectively, P＜0.01) were observed among four segment groups with graded coronary artery stenosis severity (normal; 30%-69% stenosis; 70%-90% stenosis; and beyond 90% stenosis), but not observed in parameter A. When under stress, significant differences in A (5.73±1.28, 5.63±1.01, 4.96±0.81, 4.57±0.62, respectively, P＜0.01), beta (0.67±0.17, 0.55±0.19, 0.32±0.13, 0.25±0.08, respectively, P＜0.01) and A×beta (3.81±1.20, 3.11±1.17, 1.59±0.82, 1.12±0.37, respectively, P＜0.01) were observed among the formerly mentioned groups. Graded decreases in A reserve (1.20±0.53, 1.11±0.16, 0.98±0.12, 0.99±0.13, respectively, P＜0.01), beta reserve (2.65±1.07, 2.32±0.82, 1.44±0.40, 1.29±0.34,respectively, P＜0.01) and A×beta reserve (3.05±1.63, 2.59±1.01, 1.42±0.44, 1.27±0.34, respectively, P＜0.01) could also be observed with increasing coronary stenosis severity. In five segments groups scored by WMS (1-5), concordance between contractile function and myocardial perfusion could be found both at rest (beta: 0.28±0.11, 0.22±0.08, 0.21±0.05, 0.17±0.05, 0.19±0.06, respectively, P＜0.01; A×beta: 1.29±0.48, 0.98±0.45, 0.94±0.29, 0.76±0.30, 0.92±0.32, respectively, P＜0.01) and under stress (beta: 0.59±0.20, 0.35±0.15, 0.27±0.08, 0.17±0.05, 0.20±0.05, respectively, P＜0.01; A×beta: 3.07±1.38, 1.62±0.82, 1.28±0.40, 0.78±0.24, 0.93±0.22, respectively, P＜0.01). This concordance is also valid in terms of the reserves, and the MCE parameters in segments with ameliorated contractile function are significantly higher than in those without. Conclusions Quantitative RT-MCE in conjunction with dobutamine stress shows promise in identifying and stratifying CAD and in exploring the perfusion-contractile correlation. Chin Med J 2005; 118(21):1766-1772     

Intracoronary adenosine improves myocardial perfusion

Background Myocardial perfusion associates with clinical syndromes and prognosis. Adenosine could improve myocardial perfusion of acute myocardial infarction within 6 hours, but few data are available on late perfusion of myocardial infarction （MI）. This study aimed at quantitatively evaluating the value of intracoronary adenosine improving myocardial perfusion in late reperfused MI with myocardial contrast echocardiography （MCE）.
Methods Twenty-six patients with anterior wall infarcts were divided randomly into 2 groups： adenosine group （n=12） and normal saline group （n=-14）. Their history of myocardial infarction was about 3-12 weeks. Adenosine or normal saline was given when the guiding wire crossed the lesion through percutaneous coronary intervention （PCI）, then the balloon was dilated and stent （Cypher/Cypher select） was implanted at the lesion. Contrast pulse sequencing MCE with Sonovue contrast via the coronary route was done before PCI and 30 minutes after PCI. Video densitometry and contrast filled-blank area were calculated with the CUSQ off-line software. Heart function and cardiac events were followed up within 30 days.
Results Perfusion in the segments of the criminal occlusive coronary artery in the adenosine group was better than that in the saline group （5.71：L-0.29 VS 4.95±1.22, P〈0.05）. Ischemic myocardial segment was deminished significantly after PCI, but the meliorated area was bigger in the adenosine group than in the saline group （（1.56±0.60） cm^2 vs （1.02±0.56） cm^2, P〈0.05）. The video densitometry in cntical segments was also improved significantly in the adenosine group （5.53±0.36 VS 5.26±0.35, P〈0.05）. Left ventricular ejection fraction （LVEF） was improved in all patients after PCI, but EF was not significant between the two groups （（67±6）% vs （62±7）%, P〉0.05）. There was no in-hospital or 30-day major adverse cardiac event （MACE） in the adenosine group but 3 MACE in the saline group in 30 days after     

负荷MR心肌灌注成像检测冠心病心肌缺血与冠状动脉造影及99mTc-SPECT对比的初步研究

目的 探讨负荷MR首过心肌灌注成像检测冠心病的临床价值.方法 33例经冠状动脉造影确诊的冠心病患者,男22例,女11例,平均年龄58.32岁.其中15例常规行静息-负荷99m^Tc-SPECT心肌灌注显像.采用IR-turboFLASH序列行静息-负荷MR首过心肌灌注成像及延迟期心肌灌注成像,目测定性分析心肌灌注图像,将分析结果与冠脉造影及99m^Tc-SPECT进行比较,计算其敏感性和特异性.结果 28例（28/33）191段心肌灌注减低,其中92段（92/191）可逆性灌注减低,99段（99/191）固定灌注减低;51支冠状动脉主干或其主要分支狭窄,MR首过心肌灌注成像42支狭窄冠脉供血区心肌灌注减低.以冠脉造影为参考标准,MR首过心肌灌注成像检测狭窄50%以上冠状动脉病变的敏感性及特异性分别为：82.35%和91.67%.MR首过心肌灌注成像与99m^TC-MIBI SPECT具有很好的一致性,两者符合率为：92.5%.以99m^TC-MIBI SPECT为参考标准,MR首过心肌灌注成像检测冠心病的敏感性及特异性分别为：94.74%、92.55%.结论 负荷MR首过心肌灌注成像能有效检测冠心病心肌缺血;MR首过心肌灌注成像定性评价冠心病心肌缺血具有较高的临床实用价值.     

多巴酚丁胺负荷99mTc-MIBI心肌显像诊断冠心病的价值

目的 探讨多巴酚丁胺负荷（ＤＳＴ）＾９９ｍＴｃ－ＭＩＢＩ心肌显像诊断冠心病的安全性和可靠性。方法 ７９例无心肌梗塞史的可疑冠心病患者进行ＤＳＴ心肌显像,观察各种副反应。其中４８例进行了冠脉 造影,以冠脉直径狭窄〉５０％作为冠心病诊断标准,判定ＤＳＴ心肌显像诊断冠心病的敏感性和特异性。结果 ４８例冠脉 造影患者中２０例诊断为冠心病其中１７例ＤＳＴ心肌显像异常;２４例冠脉造影正常或轻度狭窄患者中,２０     

99mTc-N-NOET运动心肌灌注显像诊断冠状动脉疾病

目的 探讨^99mTc-N-NOET( NOET) 运动肺/心比值对冠状动脉疾病(CAD)多支病变的诊断价值及其与左室舒张功能的相关性。方法 对49例经冠状动脉造影病人进行NOET运动-延迟心肌灌注断层显像,其中29例经冠状动脉造影证实动脉狭窄≥50%,20例冠状动脉正常。结果 NOET运动心肌灌注断层显像对CAD的诊断敏感性和特异性分别为86.2%和95.0%。多支病变组(0.76±0.13)NOET运动肺/心比值显著高于单支病变(0.62±0.06)和冠脉正常组(0.58±0.13)(F=18.04,P=0.002-0.001)。当NOET运动肺/心比值≥0.70时,其对冠脉多支病变的诊断敏感性和特异性分别为93.5%和83.3%。NOET运动肺/心比值与E/A比值具有非常显著的负相关性(r=-0.771, P<0.000 1)。结论 NOET运动肺/心比值对CAD病人的多支病变和左室舒张功能异常均具有诊断价值。     

负荷心肌灌注显像在女性冠状动脉心脏病诊断中的应用价值

目的评价负荷心肌灌注显像对女性冠状动脉心脏病（冠心病）的诊断价值。方法回顾分析了259例在北京阜外心血管病医院同时进行了负荷心肌灌注显像和冠状动脉造影的女性患者（间隔时间〈60d）,平均年龄（60±8）岁。其中227例进行了运动试验心肌灌注显像,32例进行了药物负荷心肌灌注显像。结果以冠状动脉管径狭窄≥50％为诊断标准,在接受运动试验心肌灌注显像检查的227例患者中,79例冠状动脉造影显示明显的冠状动脉狭窄病变,其中单支病变33例,双支病变23例,3支病变23例。累及左冠状动脉前降支67支,左冠状动脉回旋支41支,右冠状动脉40支,左主干8支。运动试验心肌灌注显像诊断女性冠心病的灵敏度为63％,特异性为97％,准确性为85％。诊断单支、双支和3支冠状动脉病变患者的灵敏度分别为61％,52％和78％。按运动试验是否达到终止指标,将227例患者分为2组,即运动试验达到终止指标组（n=137）和运动试验未达到终止指标组（n=90）。在运动试验达到终止指标组,运动试验心肌灌注显像诊断女性冠心病的灵敏度为86％。而在运动试验未达终止指标组,诊断灵敏度则为38％。在接受药物负荷心肌灌注显像检查的32例患者中,13例冠状动脉造影显示明显的冠状动脉狭窄病变。药物负荷心肌灌注显像诊断女性冠心病的灵敏度为85％,特异性为84％,准确性为84％。结论负荷心肌灌注显像可以有效诊断女性冠心病,且药物负荷心肌灌注显像更适合于运动耐力受损的老年女性患者。     

急性缺血再灌注后心肌微血管床损伤的心脏MR影像研究

目的应用心肌首过灌注MR影像分析单支冠状动脉闭塞和多支冠状动脉狭窄无闭塞所造成的心肌微血管床闭塞差异.方法33例患者临床诊断为急性心肌梗死,其中15例为单支冠状动脉完全闭塞,18例为多支冠状动脉狭窄.发病后6～12周进行心脏MR影像检查.结果11例单支冠状动脉完全闭塞和4例多支冠状动脉狭窄患者的左心室内膜下心肌内存在首过灌注缺损区,前者显著多于后者(P＜0.01).心肌首过灌注缺损区域的信号强度峰值和信号增加的最大斜率显著小于灌注正常心肌(P＜0.05).结论心肌灌注首过时相影像能够显示急性缺血再灌注损伤所导致的心内膜下微血管床闭塞.单支冠状动脉闭塞的患者较多支冠状动脉狭窄的患者更容易发生心内膜下的微血管床闭塞.     

Correlation between severity of coronary artery stenosis and perfusion defect assessed by SPECT myocardial perfusion imaging

Numerous non-invasive techniques are developed to assess the severity of coronary artery disease (CAD). Coronary angiography (CAG) is an established method for the diagnosis and to quantify the severity of coronary artery stenosis. Single photon emission computed tomography-myocardial perfusion imaging (SPECT-MPI) using Technetium-99m (Tc-99m) tetrofosmin is also a useful established technique for the assessment of severity of CAD. This prospective observational study was carried out in Bangabandhu Sheikh Mujib Medical University (BSMMU) to assess the severity of coronary artery stenosis using Tc-99m Single Photon Emission Computed Tomography myocardial perfusion imaging (SPECT-MPI) in comparison with CAG. Eighty two (82) consecutive patients with mean age 53.51(SD+/-7.08) years and Candian Cardiovascular Society (CCS) class I and II severity of chest pain, male: female ratio (4.8:1) was studied. Tc-99m SPECT-MPI was performed by one-day exercise stress and rest protocol. A total of two hundred and forty six coronary artery territories examined in this study. By CAG normal coronary arteries were found in seventy six, moderate stenosis in twenty four and severe stenosis in one hundred and forty-six coronary artery territories whereas SPECT-MPI found normal perfusion in twenty seven, mild perfusion abnormality in seventeen, moderate perfusion abnormality in thirty two and severe perfusion abnormality in one hundred and sixty five coronary artery territories. Sensitivity and specificity of SPECT-MPI using Tc-99m tetrofosmin in detecting coronary artery stenosis were 87.09% and 80.95% respectively. The positive predictive value, negative predictive value and accuracy of the test were 91.01%, 73.91% and 85.18% respectively. From this study it can be concluded that Tc-99m SPECT-MPI was a safe, effective and excellent non-invasive tool for the detection of severity of coronary artery lesion and can be used to predict severity of CAD.     

64层与16层螺旋CT冠状动脉成像比较

目的比较64层与16层螺旋CT冠状动脉成像的图像质量和分支显示率,评价64层螺旋CT诊断冠状动脉狭窄的准确性。方法对100例临床可疑冠心病患者(A组)行64层螺旋CT心电门控增强扫描,其中48例患者有常规冠状动脉造影做对照。对另外100例临床可疑冠心病患者(B组)行16层螺旋CT心电门控增强扫描。比较两组图像的质量评分和冠状动脉分支显示率。结果A组图像质量评分为(1.20±0.47)分,明显低于B组的(1.37±0.63)分(P<0.05)。两组冠状动脉近中段显示率差异无显著性(P>0.05),而远段和部分小分支显示率差异有显著性(P<0.05)。64层螺旋CT冠状动脉成像诊断冠状动脉≥50%狭窄的敏感性为94.9%(56/59),特异性为93.2%(124/133)。结论64层螺旋CT冠状动脉成像的图像质量和分支显示率较16层螺旋CT进一步提高,能够可靠诊断冠状动脉≥50%狭窄。     

Real-time three-dimensional myocardial contrast echocardiography in assessment of myocardial perfusion defects

Background Both real-time three-dimensional echocardiography (RT3DE) and myocardial contrast echocardiography (MCE) are novel imaging techniques. The purpose of this study was to confirm the feasibility and accuracy of RT3DE combined with MCE for quantitative evaluation of myocardial perfusion defects. Methods Thirteen dogs underwent ligation of the left anterior descending artery (LAD, n=6) or distal branch of the left circumflex artery (LCX, n=7) under general anaesthesia. Three to four ml of a perfluoropropane (C3F8) microbubble contrast agent was injected intravenously to assess the resulting myocardial perfusion defects with a commercially available Philips SONOS-7500 ultrasound system. After removal of the dog hearts, Evans blue dye was injected via the left and right coronary arteries to stain the myocardium at risk. In vitro anatomic measurements of myocardial mass after removal of the animals’ hearts were used as controls. Results Left ventricular (LV) mass determined by RT3DE ranged 36.7-68.9 g ［mean, （54.6±9.6） g］ before coronary artery ligation, and correlated highly (r=0.99) with in vitro measurement of LV mass ［range, 38.9-71.1 g; mean, (55.6±9.3) g］. There was no significant difference between RT3DE and in vitro measurements of LV mass ［range, 36.7-68.9 g; mean, （51.3±12.5） g. Or range, 38.9-71.1 g; mean, （53.7±12.3） g, respectively］ and under-perfused mass ［range, 0-21.4 g; mean, （12.0±6.9） g. Or range, 0-19.8 g; mean, （10.8±6.3） g, respectively］ after the LAD ligation (P&gt;0.05). Likewise, no significant difference was present between RT3DE and in vitro measurements of LV mass ［range, 50.1-65.4 g; mean, （57.5±5.9） g. Or range, 51.5-65.8 g; mean, （57.3±6.4） g, respectively］ and under-perfused mass ［range, 0-25.6 g; mean, （13.3±9.6） g. Or range, 0-22.7 g; mean, （12.8±8.1） g, respectively］ after the LCX ligation (P&gt;0.05). For all the animals with coronary ligation, LV mass measured by RT3DE ranged 35.9-68.6 g ［mean, （54.8±10.0） g］ and there was no significant difference between RT3DE and in vitro measurements of LV mass and under-perfused mass (P&gt;0.05, r=0.99). Further, the under-perfused mass derived from RT3DE ［range, 0-25.6 g; mean, （12.7±8.2） g］ correlated strongly with the in vitro measurements ［range, 0-22.7 g; mean, （11.9±7.2） g］ (r=0.96). Conclusion RT3DE with MCE is a rapid and accurate method for estimating LV myocardial mass and quantifying perfusion defects.     

心脏融合显像定量评价功能相关冠状动脉狭窄的临床研究

目的利用无创性融合影像技术对冠状动脉粥样硬化性心脏病(以下简称冠心病)进行筛选诊断,旨在评价心脏融合显像MPI/CCTA用于鉴别功能相关冠状动脉(以下简称冠脉)狭窄性病变的诊断效能及其临床价值。方法选取怀疑或确诊为冠心病的患者78例,均行常规两日法腺苷负荷/静息心肌灌注显像(myocardial perfusion imaging,MPI)和同机冠状动脉CT成像(coronary computed tomography angiography,CCTA),30 d内完成冠脉造影(coronary angiography,CAG)。MPI:采用心肌15分段法对心肌血供做定性及半定量评价;CAG和CCTA:按常规将冠脉狭窄≥50%定义为临床有意义。以MPI/CAG作为标准对MPI/CCTA对冠脉狭窄致心肌血供异常的诊断效能进行评价。结果 78例患者中,MPI结果显示正常/异常为6/72例,其中66例为心肌缺血,6例为心肌梗死;根据3支主要冠脉血管的相应供血心肌节段划分,有可逆性缺损的节段:左前降支(left anteriordescending artery,LAD)55段、左旋支(left circumflex artery,LCX)14段、右冠状动脉(right coronary artery,RCA)11段,有固定性缺损的节段:LAD 4段、RCA 3段。CCTA结果显示:冠脉正常/异常为22/56例,78例患者共有234支主要冠脉,其中有74支冠脉狭窄≥50%,106支冠脉正常。MPI/CCTA融合影像结果显示:冠脉正常/异常(存在功能相关冠脉狭窄)为22/56例,与MPI/CAG对照,得到敏感度、特异度、准确度、阳性预测值、阴性预测值分别为94.33%、72.00%、87.18%、87.71%、85.71%。基于234支主要冠脉,MPI/CCTA融合影像与MPI/CAG对照,均异常(真阳性)55段/支,MPI/CCTA正常而MPI/CAG异常(假阴性)7段/支,MPI/CCTA异常而MPI/CAG正常(假阳性)13段/支,MPI/CCTA及MPI/CAG均正常(真阴性)159段/支,诊断敏感度、特异度、准确度、阳性预测值、阴性预测值分别为88.71%、92.44%、91.45%、80.89%、95.78%。46例施行冠脉血管重建术患者均确定有功能相关冠脉狭窄,但是在67支行冠脉血管重建术的冠脉中,有25支(冠脉搭桥术CABG:8/22,36.36%;冠脉支架术PCI:17/45,37.80%)冠脉明显狭窄部位与心肌缺血区域并不匹配。结论本研究显示心脏融合影像(MPI/CCTA)用于评价功能相关冠脉狭窄具有较高的诊断效能,其优势在于可无创性评价冠脉解剖结构和功能状态,明确冠脉狭窄与其功能之间的关系,有望成为冠心病诊断,指导治疗方案的决策的首选方法。     

^99mTc-N-NOET运动心肌灌注显像诊断冠状动脉疾病

OBJECTIVE: To investigate the value of (99m)Tc-N-NOET(NOET) myocardial perfusion imaging during exercise in the diagnosis of coronary artery disease (CAD), and the relationship between exercise NOET lung/heart ratio and left ventricular diastolic function. METHODS: Exercise-delayed NOET myocardial perfusion imaging was performed in 49 patients undergoing coronary angiography, among whom 29 had coronary stenosis>or=50% and 20 normal coronary artery. RESULTS: The sensitivity and specificity of exercise NOET myocardial perfusion imaging were 86.2% and 95.0%, respectively, in the detection of CAD. The NOET lung/heart ratio of CAD patients with multiple branch involvement (0.76+/-0.13) was significantly higher than those of patients with single branch lesion (0.62+/-0.06) and with normal coronary artery (0.58+/-0.13, F=18.04, P=0.002- 0.001). When the lung/heart ratio was over 0.70, the sensitivity and specificity of the imaging for detecting the presence of multiple branch involvement were 93.5% and 83.3%, respectively. NOET lung/heart ratio showed a significant correlation with E/A ratio (r=-0.771, P<0.000 1). CONCLUSION: Exercise NOET lung/heart ratios has diagnostic values for multiple branch lesions and left ventricular diastolic function abnormalities in patients with CAD.     

核素心肌灌注断层显像检查与冠状动脉造影术对冠心病的诊断价值

[目的 ]评价99mTc甲氧基异丁基异腈心肌灌注断层显像检查诊断冠心病的准确性 ,并对心肌灌注断层显像检查与冠状动脉造影术所显示的心肌损害程度间的关系进行分析 .[方法 ]对 10 3例冠心病患者行99m Tc 甲氧基异丁基异腈心肌灌注断层显像检查和冠状动脉造影检查 ,对其结果进行对比分析 .[结果 ]冠状动脉造影术对冠心病的诊断阳性率为 96 % ,假阴性有 3例 ;心肌灌注断层显像检查对冠心病诊断的敏感性较高 ,为 94 % ,特异性较低 ,为72 % .心肌灌注断层显像检查对单支病变血管的检出灵敏度高于双支病变及 3支病变 .心肌灌注断层显像检查对前降支的检出灵敏度为 86 % ,左旋支为 6 2 % ,右冠状动脉为 82 % .心肌灌注断层显像检查与冠状动脉造影检查的结果之间存在明显差异 .[结论 ]冠状动脉造影检查可了解冠状动脉血管树的解剖 ,心肌灌注断层显像检查则从病理生理学角度提供心肌灌注和存活状况的信息 ,两者不能相互替代 ,结合此 2种检查可使冠心病诊断的准确性得到进一步的提高     

多层螺旋CT血管造影在评价冠状动脉粥样硬化性心脏病心肌缺血程度价值分析

目的分析冠状动脉粥样硬化性心脏病心肌缺血程度应用多层螺旋CT血管造影的评价价值。方法选取2014年7月至2018年7月就诊于西电集团医院及榆林市第一医院影像科的80例疑似冠心病患者,均行MSCTA检查,以CAG检查为对照,计算MSCTA检查冠脉狭窄的准确性、敏感性、特异性,并比较CAG、MSCTA检出冠脉狭窄程度情况;再行核素M PI检查,计算M S CTA检出狭窄冠脉的心肌灌注积分差、负荷总积分。结果以CAG检查为对照,在80疑似患者中,MSCTA检查显示:68例患者存在冠脉狭窄共166支,准确性、敏感性、特异性、阳性预测值、阴性预测值分别为96.68%、97.58%、95.28%、96.99%、96.19%。MSCTA、CAG检出冠脉不同狭窄的程度比较无统计差异(P>0.05)。在MSCTA检查中,轻度狭窄组的灌注积分差(0.80±0.60)分、心肌负荷总积分(2.00±1.58)分,均比中度狭窄组、重度狭窄组低,差异显著(P<0.05)。结论MSCTA不仅能评估冠状动脉狭窄程度,判断导致冠状动脉狭窄的斑块性质,还能初步判断冠心病心肌缺血的程度,具有较高的准确性、敏感性、特异性,临床应用价值高。     

Comparison of the veracity of real-time perfusion, harmonic angio, and ultraharmonic mocardial contrast imaging mode sine valuation of acute myocardial infarction area

Background Innovative advancements in ultrasound instrumentation present a number of imaging modalities for myocardial contrast echocardiography (MCE) in ischemic syndromes. How well they compare to each other in diagnostic accuracy in the detection of acute myocardial infarction is unclear. The purpose of this study was to assess the relative accuracy of 3 different imaging modes of MCE, low mechanical index (MI) real-time perfusion imaging (RTPI), triggered harmonic angio mode (HA), and ultraharmonic imaging mode (UH) in the detection of acute experimental myocardial infarction within the time frame suitable for potential reperfusion.
Methods MCE was performed in 10 open-chest dogs using RTPI, triggered HA and triggered UH modes at baseline and one hour after occlusion of left anterior descending coronary artery. Presence or absence of perfusion defects, and the perfusion defect size when present, were analyzed and compared with the infarct size delineated by triphenyltetrazolium chloride (TTC) staining.
Results The infarct area was (15.8±2.4)% by TTC staining; Perfusion defect area by MCE was similar to anatomic infarct area in all the three MCE approaches: (16.1±2.7)% by RTPI mode, (15.5±2.9)% by HA mode, and (15.5±3.0)% by UH mode. The sensitivity, specificity and overall diagnostic accuracy in the detection of myocardial infarction were 100%, 88%, and 94% for RTPI mode, 88%, 100%, and 94 % for HA mode, and 100%, 75%, and 88% for UH mode.
Conclusion All modes of MCE, RTPI, triggered HA mode and triggered UH mode have excellent diagnostic accuracy in the immediate hour of acute coronary occlusion within the optimal time frame suitable for reperfusion therapy.