MR imaging characterization of postischemic myocardial dysfunction („stunned myocardium”︁): Relationship between functional and perfusion abnormalities

Stunned myocardium has been detected in patients treated successfully with thrombolytic agents. The hypothesis of this study was that fast gradient echo (GRE) imaging could be used to characterize the regional functional and perfusion abnormalities that are indicative of myocardial stunning. This study was designed to monitor and correlate the extent of wall thickness and perfusion abnormalities as determined by fast (segmented k space) cine and contrast enhanced GRE imaging, respectively. Dogs were subjected to left circumflex (LCX) coronary artery occlusion (15 min) followed by 30-minute reperfusion (n = 8). Perivascular flow probes were used to continuously measure flow in left anterior descending (LAD) and LCX coronary arteries. Short-axis inversion recovery prepared fast GRE and cine images were acquired at baseline, at occlusion, and at 1, 10, and 30 minutes of reflow. Regional signal intensity and percent systolic wall thickening were determined at 26 equally spaced circumferential positions to compare the extent of functional and perfusion abnormalities. During occlusion and reperfusion, the ischemic region was demonstrated on contrast-enhanced images as a hypointense and hyperintense region, respectively. During occlusion, the extent of the perfusion defect (32% ± 2% of the circumference of the equatorial slice) correlated closely (r = .74) with the extent of contractile dysfunction (35% ± 2%). After reperfusion, there was transient recovery in the percent wall thickening (26% ± 4% vs 36% ± 4% normal), coinciding with the reactive hyperemic response, but this was followed by a significant decline in wall thickening at 10 minutes (19% ± 4%) and 30 minutes (12% ± 2%). Fast MR imaging may be useful to monitor postischemic myocardial abnormalities after thrombolytic therapy and the response to pharmacologic interventions.     

Contrast agents and cardiac MR imaging of myocardial ischemia: from bench to bedside

This review paper presents, in the first part, the different classes of contrast media that are already used or are in development for cardiac magnetic resonance imaging. A classification of the different types of contrast media is proposed based on the distribution of the compounds in the body, their type of relaxivity and their potential affinity to particular molecules. In the second part, the different uses of the extracellular type of T1-enhancing contrast agent for myocardial imaging is covered from the detection of stable coronary artery disease to the detection and characterization of chronic infarction. A particular emphasis is placed on the clinical use of gadolinium-chelates, which are the universally used type of MRI contrast agent in the clinical routine. Both approaches, first-pass magnetic resonance imaging (FP-MRI) as well as delayed-enhanced magnetic resonance imaging (DE-MRI), are covered in the different situations of acute and chronic myocardial infarction.     

Influence of bolus volume and dose of gadolinium chelate for first-pass myocardial perfusion MR imaging studies

First-pass MR myocardial perfusion measurements require a well-defined left ventricular (LV) blood pool input function. We used a peripheral intravenous (IV) injection of a gadolinium (Gd) chelate to obtain a well-characterized LV time-intensity curve. Using a strongly T1-weighted subsecond MR sequence, we performed cardiac MR imaging after administering an IV bolus injection of one of three different doses of the Gd chelate: a standard dose (0.1 mmol/kg, group I, n = 8); a low dose with two bolus volumes (0.01 mmol/kg, l/10e bolus volume, group n, n = 7, and 0.01 mmol/kg diluted in saline, same bolus volume as group I, group III, n = 3); and an intermediate dose (0.05 mmol/kg, group IV, n = 5). Unlike in group I (high dose), in groups n and m (low dose), the LV curve had a well-defined first peak, followed by a downslope and a recirculation peak. With the intermediate dose (group IV), a saturation effect still remained on the LV curve. The signal intensity (SI) enhancement of the myocardium was respectively 580 ± 77% at 0.1 mmol/kg, 362 ± 95% at 0.05 mmol/kg, and at 0.01 mmol/kg, it was 184 ± 33% in group II and 272 ± 8% in group m. In conclusion, with subsecond T1-weighted MR imaging and a low dose of Gd chelate (i.e., 0.01 mmol/kg). the LV input function is a well-defined first step for MR perfusion modeling.     

急性缺血再灌注心肌磁共振成像实验研究

目的：通过MR灌注成保评价急性梗死心肌组织血流灌注特点。方法：采用结扎左前降支90min存灌注的方法建立为存灌注梗死心肌组，对6只犬行MRI灌注成保及延迟扫描，观察犬心肌缺血存灌注模型梗死心肌MRI特点。结果：犬心肌缺血存灌注梗死心肌MR灌注成保表现为灌注缺损区，延迟扫描表现为高信号。结论：MR灌注成保有助于评价心肌血流，诊断心肌缺血存灌注梗死心肌。     

T1-Weighted MR imaging of the brain using a fast inversion recovery pulse sequence

The purpose of this paper was to develop and evaluate a fast inversion recovery (FIR) technique for T1-weighted MR imaging of contrast-enhancing brain pathology. The FIR technique was developed, capable of imaging 24 sections in approximately 7 minutes using two echoes per repetition and an alternating echo phase encoding assignment. Resulting images were compared with conventional T1-weighted spin echo (T1SE) images in 18 consecutive patients. Compared with corresponding T1SE images, FIR images were quantitatively comparable or superior for lesion-to-background contrast and contrast-to-noise ratio (CNR). Gray-to-white matter and cerebrospinal fluid (CSF)-to-white matter contrast and CNR were statistically superior in FIR images. Qualitatively, the FIR technique provided comparable lesion detection, improved lesion conspicuity, and superior image contrast compared with T1SE images. Although FIR images had greater amounts of image artifacts, there was not a statistically increased amount of interpretation-interfering image artifact. FIR provides T1-weighted images that are superior to T1SE images for a number of image quality criteria.     

MRI of the uterus, uterine cervix, and vagina: diagnostic performance of dynamic contrast-enhanced fast multiplanar gradient-echo imaging in comparison with fast spin-echo T2-weighted pulse imaging

The aim of this study was to compare the diagnostic performance of contrast-enhanced fast multiplanar gradient-echo (GRE) and T2-weighted fast spin-echo (FSE) image sets in the assessment of uterus, cervix, and vagina. Fast (up to 20 contiguous sections in 23 s) multiplanar GRE and FSE images of 45 patients referred for imaging of the female pelvis were evaluated retrospectively with regard to overall image quality and the ability to detect normal anatomic structures, as well as lesion conspicuity. Results were compared with histologic findings (n = 29) or clinical follow-up. Furthermore, a quantitative assessment of contrast-to-noise ratios among normal uterine and cervical structures as well as uterine lesions was performed for both sequences. On GRE images, uterine and cervical differentiation was best seen on the image sets acquired 15 and 60 s following contrast enhancement and results were significantly better compared with delayed images (p < 0.05). Delineation of the junctional zone was significantly (p < 0.05) better on FSE compared with GRE images; no significant difference was seen for the other anatomic structures. Overall image quality of GRE and FSE images was similar. Sensitivity for lesion detection based on both GRE and FSE images was 96 % with a sensitivity of 93 % for GRE, and 81 % for FSE images alone, respectively. Using the extended McNemar χ ² test, the difference in diagnostic performance between FSE and GRE revealed no significant difference, whereas the combination of both techniques performed better than FSE imaging alone (p < 0.05). The presented data suggest that dynamic contrast-enhanced GRE imaging should be part of an MR examination of the female pelvis. Combined GRE and FSE imaging provide an excellent sensitivity in the assessment of uterine and vaginal pathologies. Received 8 August 1997; Revision received 23 December 1997; Accepted 16 February 1998     

负荷CT心肌灌注在冠心病中应用的初步研究进展

冠心病是因冠状动脉血流和心肌氧需求之间不平衡而导致的缺血性心肌损害,仅凭冠状动脉狭窄来诊断冠心病不能准确反映心肌缺血状况,也不能对缺血性心脏事件的发生做出较准确的预警.负荷CT心肌灌注成像则可定性及定量地评价心肌血流状态,检测心肌微循环及心肌活性,对心脏事件的发生进行预测并对早期干预提供客观依据等.对负荷CT心肌灌注的检测原理、方法及在冠心病中临床应用的初步研究进展进行综述.     

SPECT心肌灌注显像在糖尿病无症状性心肌缺血中的临床价值

冠心病是糖尿病患者常见的并发症,其中,无症状性心肌缺血由于起病隐匿而不被重视,容易发生严重的心血管事件。SPECT心肌灌注显像作为常用的无创性检查方法,在心肌缺血的筛查中发挥着越来越重要的作用。该文对SPECT心肌灌注显像在糖尿病患者无症状性心肌缺血的筛查、诊断及预后判断中的应用进行了综述。     

Reperfused ischemia of the rat intestine: Detection by MR imaging with polylysine-Gd-DTPA enhancement

To detect reperfused ischemia of the rat intestine, T₂-weighted spin-echo images were acquired, followed by T₁-weighted images before and after administration of polylysine-Gd-DTPA or Gd-DTPA. Before administration of the contrast agent, the reperfused intestine was hyperintense on T₂-weighted images, and to a lesser extent on T₁-weighted images. After administration of polylysine-Gd-DTPA, the reperfused intestine enhanced more than the normal one, giving a significantly better contrast-to-noise (CNR) ratio than on unenhanced images. Gd-DTPA induced the same enhancement of the reperfused and the normal intestine and the CNR was lower than on unenhanced T₂-weighted images. Reperfused intestinal ischemia could thus be better detected on polylysine-Gd-DTPA-enhanced MR images than on unenhanced images or on Gd-DTPA- enhanced images.     

中华小型猪急性心肌缺血的综合影像学研究

目的 研究MSCT、MRI、SPECT对中华小型试验猪急性心肌缺血模型的显示效果.方法 中华小型猪共6只,所有试验猪接受MSCT扫描1次后结扎前降支中远段,在结扎后2、4、6、8 h内,每2 h MSGT扫描1次.术后24 h内进行MR、SPECT及再次完成MSCT扫描各1次,最后处死动物行病理检查.使用重复测量因素的方差分析,比较左心室前壁首过灌注减低区域与左心室侧壁首过灌注无减低区域的首过灌注CT值从术前至术后2、4、6、8、24 h的变化;使用单因素方差分析检验术前及术后2、4、6、8、24 h的心功能变化;使用配对t检验分析比较氯化三苯基四氮唑(TTC)染色病理、MSCT、MRI相互间测量梗死面积的百分比.结果 术中死亡动物1只,完成检查5只.术后2、4、6、8及24 h的MSCT动脉期减低区域,术后24 h SPECT显示的灌注减低区域,MRI显示的首过灌注减低区,病理显示的心肌梗死大致范围均位于左心室前壁.3只试验猪4～8 h的MSCT延迟扫描出现灌注减低区域边缘强化.动脉期灌注减低区域的术前与术后各时间段的CT值分别为75.9、36.4、35.2、37.8、37.4、33.3 HU,差异均有统计学意义(F=12.341,P＜0.01),术后各时间段间的CT值差异没有统计学意义(F=2.278,P=0.792).术前及术后2、4、6、8、24 h的每搏输出量(SV)平均容积分别为21.7、11.9、10.3、11.4、12.3、12.6 ml(F=22.349,P＜0.01);收缩末期(ESV)平均容积分别为15.2、23.4、25.0、24.4、25.3、22.8ml(F=8.810,P＜0.01);舒张末期(EDV)平均容积分别为37.0、35.4、35.0、35.7、37.6、37.5 ml(F=2.339,P=0.079);射血分数(EF)平均依次为58.9%、33.8%、29.0%、31.9%、32.6%、33.5%(F=27.240,P＜0.01),除EDV外差异均有统计学意义.5只猪测得的梗死面积占所测层面整个心肌比例分别为MSCT(39.4±12.6)%、MRI(37.2±10.0)%,TTC(35.9±9.6)%.TTC与MSCT(t=0.612,P=0.574)、TTC与MRI(t=0.820,P=0.458)、MSCT与MRI(t=0.425,P=0.692)间差异均无统计学意义.结论 MSCT动脉期、MRI首过灌注、SPECT显示梗死区域与TTC染色梗死部位均位于左心室前壁.MSCT动脉期与MRI首过灌注显示的低灌注面积与TTC染色梗死面积有很好的相关性.急性心肌缺血后24 h内缺血心肌密度、心功能没有随时间发生变化.     

Dynamic susceptibility contrast perfusion imaging of cerebral ischemia in nonhuman primates: comparison of Gd-DTPA and NMS60

PURPOSE: To study a new gadolinium (Gd) contrast agent-NMS60-for MR perfusion-weighted imaging (PWI) of brain tissue. MATERIALS AND METHODS: NMS60 is a Gd3+ trimer with a molecular weight of 2158 Daltons, and a T2 relaxivity almost three times higher than that of Gd-DTPA. Middle cerebral artery (MCA) occlusion was induced in nine nonhuman primates. The animals were scanned acutely and for up to six follow-up time points. PWI peak, and time-to-peak maps were generated, and perfusion deficit volumes were measured from these maps. The values of peak, time-to-peak, and perfusion deficit volume were compared between NMS60 and GD-DTPA. RESULTS: These results demonstrate that there was no significant difference in our calculated perfusion parameters between the two contrast agents. CONCLUSION: The two agents were found to be equally effective for PWI for acute and chronic stroke in primates. Along with its previously demonstrated advantage for T1-enhanced imaging, the current results show that NMS60 is a viable contrast agent for use in stroke patients.     

Importance of perfusion in myocardial viability studies using delayed contrast-enhanced magnetic resonance imaging

PURPOSE: To investigate whether an extracellular gadolinium-(Gd)-based contrast agent (CA) enters nonperfused myocardium during acute coronary occlusion, and whether nonperfused myocardium presents as hyperintense in delayed contrast-enhanced (DE) MR images in the absence of CA in that region. MATERIALS AND METHODS: The left anterior descending coronary artery (LAD) was occluded for 200 minutes in six pigs. The longitudinal relaxation rate (R(1)) in blood, perfused myocardium, and nonperfused myocardium was repeatedly measured using a Look-Locker sequence before and during the first hour after administration of Gd-DTPA-BMA. RESULTS: While blood and perfused myocardium showed a major increase in R(1) after CA administration, nonperfused myocardium did not. R(1) in nonperfused myocardium was significantly lower than in blood and perfused myocardium during the first hour after CA administration. When the signal from perfused myocardium was nulled, demarcation of the hyperintense nonperfused myocardium was achieved in all of the study animals. CONCLUSION: Gd-DTPA-BMA does not enter ischemic myocardium within one hour after administration during acute coronary occlusion. The ischemic region with complete absence of CA still appears bright when the signal from perfused myocardium is nulled using inversion-recovery DE-MRI. This finding is important for understanding the basic pathophysiology of inversion-recovery viability imaging, as well as for imaging of acute coronary syndromes.     

MR imaging of the internal auditory canal and inner ear at 3T: comparison between 3D driven equilibrium and 3D balanced fast field echo sequences

OBJECTIVE: To compare the use of 3D driven equilibrium (DRIVE) imaging with 3D balanced fast field echo (bFFE) imaging in the assessment of the anatomic structures of the internal auditory canal (IAC) and inner ear at 3 Tesla (T). MATERIALS AND METHODS: Thirty ears of 15 subjects (7 men and 8 women; age range, 22-71 years; average age, 50 years) without evidence of ear problems were examined on a whole-body 3T MR scanner with both 3D DRIVE and 3D bFFE sequences by using an 8-channel sensitivity encoding (SENSE) head coil. Two neuroradiologists reviewed both MR images with particular attention to the visibility of the anatomic structures, including four branches of the cranial nerves within the IAC, anatomic structures of the cochlea, vestibule, and three semicircular canals. RESULTS: Although both techniques provided images of relatively good quality, the 3D DRIVE sequence was somewhat superior to the 3D bFFE sequence. The discrepancies were more prominent for the basal turn of the cochlea, vestibule, and all semicircular canals, and were thought to be attributed to the presence of greater magnetic susceptibility artifacts inherent to gradient-echo techniques such as bFFE. CONCLUSION: Because of higher image quality and less susceptibility artifacts, we highly recommend the employment of 3D DRIVE imaging as the MR imaging choice for the IAC and inner ear.     

FAIR and dynamic susceptibility contrast-enhanced perfusion imaging in healthy subjects and stroke patients

PURPOSE: To compare dynamic susceptibility contrast-enhanced magnetic resonance imaging (DSC-MRI) and the flow-sensitive alternating inversion recovery (FAIR) technique for measuring brain perfusion. MATERIALS AND METHODS: We investigated 12 patients with acute stroke, and 10 healthy volunteers with FAIR and DSC maps of regional cerebral blood volume (rCBV), mean transit time (MTT), and regional cerebral blood flow (rCBF). RESULTS: In volunteers good gray/white-matter contrast was observed in FAIR, rCBF, and rCBV maps. Regions with high signal intensities in FAIR matched well with high values of rCBV and rCBF. In ischemic stroke patients a high correlation (r = 0.78) of the ipsi- to contralateral signal intensity ratios in FAIR and rCBF was observed in areas with perfusion abnormalities. In contrast, FAIR and rCBV (r = 0.50), and FAIR and MTT (r = -0.22) correlated only modestly. Furthermore, FAIR and rCBF demonstrated similar sizes of perfusion abnormality. CONCLUSION: This study demonstrates for the first time that FAIR and rCBF depict similar relations of perfusion in ischemic stroke patients and healthy subjects.     

Functional imaging in the assessment of myocardial infarction: MR imaging vs. MDCT vs. SPECT

Purpose

To intraindividually compare magnetic resonance (MR) imaging, ECG-gated multi-detector spiral computed tomography (MDCT) and gated single photon emission computed tomography (SPECT) for the evaluation of global and regional myocardial function and the identification of myocardial perfusion abnormalities.

Materials and methods

Nine patients (8 men; 55.1 ± 8.9 years) with a history of myocardial infarction (MI) were included in this retrospective study. All patients had undergone segmented k-space steady state free precession MR imaging, ^99mTc-MIBI gated myocardial perfusion SPECT and contrast enhanced ECG-gated 16-MDCT. Ventricular volumes and ejection fraction (EF) were calculated. Left ventricular (LV) wall motion at rest was analyzed. For SPECT and arterial phase MDCT perfusion abnormalities were assessed. Data was compared with Lin's concordance-correlation coefficient (ρ_c), Bland-Altman plots and kappa statistics.

Results

For EF, there was an excellent concordance and correlation (ρ_c = 0.99) between SPECT (EF = 41.7 ± 10.4%), MDCT (EF = 42.2 ± 11.1%), and MR imaging (EF = 41.9 ± 11.4%). Considering MR imaging as standard of reference, MDCT (κ = 0.86) is superior to SPECT (κ = 0.51) for the assessment of the regional wall motion at rest. There was a good agreement between SPECT and MDCT regarding the detection of perfusion abnormalities (κ = 0.62).

Conclusion

MDCT, MR imaging, and SPECT allow for the reliable assessment of global and regional left ventricular function in patients with a history of MI. MDCT also allows to some extent for the detection of perfusion abnormalities. With its potential to assess both, the coronary arteries as well as the myocardium, MDCT a promising modality for the comprehensive diagnostic work-up in patients with suspected myocardial ischemia.     

Assessment of myocardial perfusion and viability from routine contrast-enhanced 16-detector-row computed tomography of the heart: preliminary results

To assess the diagnostic accuracy of 16-detector-row computed tomography (16DCT) of the heart in the assessment of myocardial perfusion and viability in comparison to stress perfusion magnetic resonance imaging (SP-MRI) and delayed-enhancement magnetic resonance imaging (DE-MRI). A number of 30 patients underwent both 16DCT and MRI of the heart. Contrast-enhanced 16DCT data sets were reviewed for areas of myocardium with reduced attenuation. Both CT and MRI data were examined by independent reviewers for the presence of myocardial perfusion defects or myocardial infarctions (MI). Volumetric analysis of the hypoperfusion areas in CT and the infarct sizes in DE-MRI were performed. According to MRI, myocardial infarctions were detected in 11 of 30 cases, and perfusion defects not corresponding to an MI were detected in six of 30 patients. CTA was able to detect ten of 11 MI correctly (sensitivity 91%, specificity 79%, accuracy 83%), and detected three of six hypoperfusions correctly (sensitivity 50%, specificity 92%, accuracy 79%). Assessing the volume of perfusion defects correlating to history of MI on the CT images, a systematic underestimation of the true infarct size as compared to the results of DE-MRI was found (P<0.01). Routine, contrast-enhanced 16-detector row CT of the heart can detect chronic myocardial infarctions in the majority of cases, but ischemic perfusion defects are not reliably detected under resting conditions.Dr. Sanzs work is supported in part by a Research Grant (Beca para la Formación en Investigación Post-Residencia) from the Spanish Society of Cardiology.     

Magnetic resonance myocardial first-pass perfusion imaging: parameter optimization for signal response and cardiac coverage.

Fast imaging techniques allow monitoring of contrast medium (CM) first-pass kinetics in a multislice mode. Employing shorter recovery times improves cardiac coverage during first-pass conditions, but potentially flattens signal response in the myocardium. The aim of this study was therefore to compare in patients with suspected coronary artery disease (CAD) two echo-planar imaging strategies yielding either extended cardiac coverage or optimized myocardial signal response (protocol A/B, six/four slices; preparation pulse, 60 degrees /90 degrees; delay time, 10/120 msec; readout flip angle, 10 degrees /50 degrees; respectively). In phantoms and myocardium of normal volunteers (N= 10) the CM-induced signal increase was 2.5-3 times higher with protocol B (P < 0.005) than with protocol A. For the detection of individually diseased coronary arteries (> or =1 stenosis with > or =50% diameter reduction on quantitative coronary angiography (QCA)), receiver-operator characteristics of protocol B (signal upslope in 32 sectors/heart) yielded a sensitivity/specificity of 82%/73%, which was superior to protocol A (P < 0.05, N= 14). For the overall detection of CAD, the sensitivity/specificity of protocol B was 85%/81%. An adequate signal response in the myocardium is crucial for a reliable detection of perfusion deficits during first-pass conditions. The presented protocol B detects CAD with a sensitivity and specificity similar to scintigraphic techniques.     

Comparison of different contrast agents and doses for quantitative MR myocardial perfusion imaging

PURPOSE: To investigate three different contrast agents at different injection volumes for repetitive quantitative multislice myocardial perfusion imaging using the prebolus technique. MATERIALS AND METHODS: Two consecutive prebolus perfusion measurements were performed on a 1.5 T scanner using identical injection volumes for the first and second examination to test the reproducibility for possible rest and stress examination in normal volunteers. Either 1-8 mL, 1-12 mL Gd-DTPA, 1-4 mL, 1-6 mL, 1-9 mL Gd-BOPTA, or 1-4 mL, 1-6 mL gadobutrol were applied. RESULTS: In cases where injection volumes were sufficiently small, there was no indication of significant differences in quantitative perfusion values with respect to the different contrast agents. Increasing the bolus volume improved the contrast-to-noise ratio (CNR) but led to saturation effects and underestimation of the true perfusion. The highest CNR was measured for gadobutrol (6 mL, p < 0.0005 compared to 8 mL Gd-DTPA). The smallest difference of perfusion values between the first and the second prebolus examination was found for Gd-BOPTA (p < or = 0.006 compared Gd-DTPA). CONCLUSION: Prebolus examinations for quantitative myocardial perfusion imaging are possible with all three contrast agents for sufficient small injection volumes. Gd-BOPTA was found to be advantageous for a combined quantitative rest and stress examination.     

磁共振心肌灌注成像及心肌活力分析诊断急性心肌梗死的价值

目的:研究磁共振心肌灌注成像及心肌活力分析在诊断急性心肌梗死中的价值。方法:选择37例急性心肌梗死患者作为观察组,同时选出37例无心血管疾病的正常志愿者作为对照组,均行灌注成像和心肌活力分析,观察2组相应心肌信号强度平均值、首过最大上升斜率及首过时间。结果:磁共振心肌灌注成像延迟期观察组梗死心肌的信号强度平均值为73.23±35.24,对照组正常心肌(对应观察组梗死区)为17.99±8.15,2组对比差异具有统计学意义(P<0.01);观察组梗死心肌的首过最大上升斜率平均值为32.85±20.69,对照组正常心肌(对应观察组梗死区)为44.68±23.60,2组对比差异具有统计学意义(P<0.01)。观察组患者心肌梗死区首过时间平均为(5.04±1.74)s,对照组正常心肌(对应观察组梗死区)为(2.82±1.82)s,2组对比差异具有统计学意义(P<0.01)。结论:磁共振心肌灌注成像及心肌活力分析可用于诊断急性心肌梗死。     

平板运动试验及心肌灌注显像在飞行人员不典型心肌缺血诊断中的对比研究

目的评价活动平板运动试验对飞行人员不典型心肌缺血的诊断价值，并和心肌灌注显像及冠状动脉造影作对比研究，为其医学鉴定提供参考依据。方法不典型胸痛患者38例，均行活动平板运动试验及心肌灌注显像，结果分别与冠状动脉造影相比较。结果38例冠状动脉造影检查中有13例冠状动脉狭窄病变；运动试验阳性15例，阴性23例；心肌灌注显像检出可逆性心肌缺血16例，阴性22例。运动试验、心肌灌注显像诊断冠心病心肌缺血的灵敏度、特异性、准确性分别为53．8％、68．0％、63．2％和92．3％、84．0％、86．8％。结论活动平板运动试验出现异常ST—T改变，对诊断不典型胸痛患者冠心病心肌缺血有一定的意义，对飞行人员群体的冠心病诊断和排除亦有一定的应用价值。心肌灌注显像在飞行人员体检中的应用价值高于平板运动试验。