心电图ST段改变与99mTC—MIBI心肌灌注显像对比分析

为分析心电图ST段改变与^99m“TC—MIBI心肌灌注显像诊断心肌缺血。对126例心电图ST段改变患者同时行^99mTC—MIBI静息心肌灌注显像。126例均为我院门诊及住院患者，临床诊断冠心病或可疑冠心病。其中男性94例,女性32例，年龄35～72岁，进行2次以上心电图检查．均有ST段改变。同时行^99mTC—MIBI静息心肌灌注显像，采用Elscint APEX—SPX 6HR SPECT静息状态下采集，断层处理。连续两层并在两个不同方向的相应节段上，出现放射性分布减低区,考虑为心肌缺血。     

冠状动脉腔内心电图与核素心肌显像识别存活心肌的对照研究

目的 　 对照研究冠状动脉腔内心电图 (intracoronaryelectrocardiogram ,IC ECG)与核素心肌显像在识别存活心肌中的准确性及实用性 ,观察IC ECG是否较核素心肌显像具有准确率高、简便易行等优点 ,并从心电学角度为临床判断存活心肌提供一个新的指标。　方法　 4 2例心肌梗死患者 (梗死后 2周～ 3个月 ) ,采用经皮冠状动脉腔内成形术 (PTCA)支架术前静脉滴注小剂量多巴酚丁胺 (3μg·kg- 1 ·min- 1 )时合用舌下含服硝酸甘油 (0 5mg) 99mTc MIBI心肌显像 ,与术后 3周静息99mTc MIBI心肌显像的对照观察多巴酚丁胺与硝酸酯合用预测存活心肌的准确度及安全性。所有患者于PTCA支架术中同步记录IC -ECG及体表心电图 ,观察、测算J点后 4 0ms处ST段改变。根据IC ECG的ST段改变将患者分为 2组 ,A组 :IC ECG在术中ST段抬高 >0 2mV ;B组 :IC ECG在术中ST段抬高 <0 2mV。以术后 3周时静息99mTc MIBI心肌显像识别存活心肌者为阳性对照 ,观察IC ECG的ST段改变是否能够预测存活心肌。　结果　PTCA支架术前静息99mTc MIBI心肌灌注显像共有 16 4个节段心肌摄取异常。药物介入99mTc MIBI心肌灌注显像及PTCA支架术后 3周静息99mTc MIBI心肌灌注显像放射性分布异常节段心肌血流灌注改善。以PTCA支架术后 3周为标准 ,药物     

99m Tc-MIBI心肌断层显像与冠状动脉造影诊断冠心病的对比研究

冠状动脉造影 (CAG)和99mTc MIBI心肌断层显像对于冠心病 (CAD)的诊断及预后的评价文献报道不多 ,其临床意义虽已被肯定 ,但在灵敏度、特异性方面仍然存在一些异议。本文通过对 15 0例患者进行冠状动脉造影和99mTc MIBI心肌断层显像的对比研究 ,以其中 2 9例冠状动脉 (冠脉 )正常患者作为对照组 ,以冠脉造影结果为标准 ,评价心肌断层显像检出冠心病的灵敏度、特异性与冠脉病变程度的关系。资料与方法一、临床资料本组 15 0例均以胸闷、胸痛为主诉 ,均经CAG及心肌断层显像检查 ,其中CAG诊断冠心病有 10 3例 (包括心肌梗死2 7例 ,心…     

^99mTc—MIBI心肌灌注断层显像对老年冠心病的诊断价值

采用~(99m)Tc—MIBI心肌灌注断层显像方法检测冠心病心绞痛和心肌梗塞患者74例,并与ECG进行对比分析。结果表明,~(99m)Tc—MIBI心肌灌注断层显像对缺血性心脏病检出率(90.5％)高于ECG(73.0％)。运动和静息心肌灌注断层显像对比结果证明,运动试验可提高检出率和特异性,并发现3例反向分布,说明核素心肌灌注断层显像安全无创伤、检出率高,更适合老年冠心病患者检查。     

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。     

099mTc—MIBI硝酸异山梨酯介入显像对冠脉支架置入术后心肌血流灌注的评估

目的：探讨99mTc锝-甲氧基异丁基异腈（99mTc—methoxyisobutyl isonitrile,Tc—MIBI）评估冠状动脉支架置入术（支架置入术）后损伤区心肌细胞血流灌注状况的价值。方法：40例行支架置入术患者,分别在置入术前、后进行99mTc—MIBI心肌静态显像及其硝酸异山梨酯（ISDN）介入显像,对比分析损伤区心肌细胞血流灌注改善程度。结果：40例患者冠状动脉共有360个节段。术前Tc—MIBIISDN介入显像异常10g个节段（29．2％）,显著少于Tc—MIBI静态显像异常的178个节段（49．4％,P〈0．01）。支架置入术后ISDN介入显像异常91个（25．3％）节段也显著少于静态显像异常的112个节段（31．1％,P〈0．05）。结论：99mTc—MIBI—ISDN介入显像较99mTc—MIBI心肌静态显像更能反映支架置入术后心肌血流灌注情况。     

硝酸甘油介入99 mTc-MIBI心肌断层显像对存活心肌的评价

为评价硝酸甘油（NTG）介入99m锝-甲氧基异丁基异脯（99mTc－MIBI）心肌显像估测存活心肌的价值，对24例心肌梗死病人不同日行两种方案的99mTc－MIBI心肌显像：一种在静息状态进行，另一种在舌下含服NTG0．6mg后进行。8例经皮腔内冠状动脉成形术（PTCA）的病人术后2～4周随访了99mTc－MIBI静息显像。结果显示，99mTc－MIBI静息显像有118个心肌节段摄取正常，98个摄取异常（16个节段摄取减低，82个摄取严重减低），在98个摄取异常的节段中，NTG介入99mTc－MIBI显像有39个（39．80％）节段摄取增加。8例行PTCA的病人，NTG介入99mTC－MIBI显像证实为可逆性缺损的心肌节没有84．21％在PTCA后心肌灌注改善（存活心肌），而为NTG介入99mTc－MIBI显像证实为不可逆性缺损的心肌节段有88．24％在PTCA后心肌灌注无改善。NTG介入99mTc－MIBI显像预测存活心肌的准确性为86．11％。表明，NTG介入99mTc－MIBI心肌显像可提高缺血但存活心肌的检出率。     

硝酸甘油介入~(99m)Tc-甲氧基异丁基异腈心肌灌注断层显像评估存活心肌

目的　评估静息及硝酸甘油介入99mTc 甲氧基异丁基异腈 (99mTc MIBI)心肌灌注断层显像在存活心肌检测中的应用价值。方法　对心肌梗死 2 0例于血管重建术前分别行静态及硝酸甘油介入显像 ,血管重建术后 1个月重复静息心肌显像并进行对比分析。结果　 2 0例共有 1 4 4个异常灌注的心肌节段 ,硝酸甘油介入后有 72个心肌节段灌注改善 ,血管重建术后有 77个心肌节段灌注改善。硝酸甘油介入改善的 72个节段术后有 62个节段改善 ;而术前无改善的 72个节段术后只有 1 5个节段改善 ,硝酸甘油介入99mTc MIBI心肌灌注显像对存活心肌预测的阳性预测值为 86 .1 % ,阴性预测值为 79.2 % ,预测准确率为 82 .6%。结论　硝酸甘油介入99mTc MIBI心肌灌注断层显像是可供临床检测心肌存活的安全、有价值的方法     

99mTc-MIBI心肌灌注断层显像鉴别诊断扩张型和缺血性心肌病

目的 探讨核素心肌显像对扩张型心肌病和缺血性心肌病的诊断价值。方法 对23例扩张型心肌病(dilated cardiomyopathy，DCM)和29例缺血性心肌病(ischemic cardiomyopathy，ICM)进行^99mTc—MIBI心肌断层显像，观察其在心肌的分布情况。结果 所有52例患者的显像均有放射性分布异常。DCM组47．8％(11／23)放射性均匀减低，34．8％(8／23)呈花斑样改变；ICM组则96．6％(28／29)有节段性放射性缺损，无花斑样改变病例。若以节段性放射性缺损作为诊断缺血性心肌病的标准则其敏感性为96．6％，特异性为93．3％；若以均匀减低和／或花斑样分布而无完全缺损节段作为扩张型心肌病的诊断标准，则DCM组有82．6％的病例符合。结论 ^99mTc—MIBI心肌断层显像的特征对扩张型心肌病和缺血性心肌病的诊断和鉴别诊断具有较高的应用价值，与心血管造影有较好的相关性。     

99m Tc-MIBI心肌断层显像诊断冠心病的临床价值

1984年美国报道了^99mTc-特丁基异晴(TBI)做心肌灌注显像，获得成功^[1]，作为新的显像剂应用于临床。许多研究表明^99mTc标记的异晴类化合物中尤以^99mTc-MIBI心肌显像最佳，在临床应用中取得了满意的效果。本文就^99mTc-MIBI静息心肌断层显像、运动负荷心肌断层显像、潘生丁负荷心肌断层显像等方法对冠心病的诊断价值作一评价。     

腺苷负荷心肌灌注显像141例临床分析

目的:腺苷负荷心肌灌注显像(MPI)与冠状动脉造影(CAG)2种检查方法的结果对比分析。方法:对141例患者分别行腺苷负荷MPI及CAG检查,并使用校正的TIMI血流分级(CTFC)方法评价冠状动脉血流速度。对2种方法的检查结果进行比较分析。结果:腺苷负荷MPI阳性的99例患者中,经CAG检查确诊冠心病者52例,冠状动脉慢血流(CSF)者37例,冠状动脉正常者10例。腺苷负荷MPI对冠心病诊断的灵敏度和特异度为92.9%和44.7%;对CSF诊断的灵敏度和特异度为82.2%和75.0%。结论:腺苷负荷MPI阳性者中一部分为冠心病患者,一部分为CSF者,对于腺苷负荷MPI异常的患者需进一步行CAG检查以明确病情。     

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.     

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。     

The value of dipyridamole-technetium-99m carbomethoxyisopropylisonitrile (CPI) myocardial tomography imaging in diagnosing coronary artery disease

Fifty cases of clinically proven or suspected coronary artery disease (CAD) underwent dipyridamole-technetium-99m CPI (DP-99mTc. CPI) myocardial tomography imaging and coronary angiography. All cases with angiographically proven CAD had positive DP-99 mTc. CPI. The sensitivity was 100%. Six of 13 cases with normal coronary arteriogram showed false positive results (3 cases of hypertrophic cardiomyopathy and 3 cases of chest pain with unknown causes). Therefore, the specificity was 53.8% (7/13). The positive predictive accuracy of DP-99m Tc. CPI myocardial imaging was 88.0%. However, We do not consider it justified to apply this statistics to general population as our patients were highly selected. One hundred and twelve myocardial segments of left ventricle were shown to be infarcted or ischemic by either radionuclear imaging or ECG. In 108 segments with abnormal images, only 10 in patients with hypertrophic cardiomyopathy had normal coronary artery supply. Therefore, the reliability of DP-99 mTc. CPI myocardial imaging to display infarcted or ischemic segments was 91.0% (102/112). The ability for 99mTc. CPI imaging to differentiate between infarcted and ischemic lesions was somewhat indefinite, especially in case of localized infarction. The reason of this shortcoming was discussed. Ninety segments were shown to be infarcted or ischemic by ECG, 4 of which had no corresponding coronary artery stenosis. However, in 12 of the 22 segments with normal ECG pattern the corresponding coronary arteries were either occluded or stenosed, resulting in 54.5% (12/22) false negativity. Most of these false negatives were found in posterior and septal walls. Angina pectoris after dipyridamole infusion occurred in 4 of our 50 patients.(ABSTRACT TRUNCATED AT 250 WORDS)     

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。     

锝-氮-氮欧乙替心肌灌注显像对冠心病的诊断评价

目的评价锝-氮-氮欧乙替（^99mTc-N—NOET）心肌灌注显像检测冠心病的价值。方法对42例临床疑诊冠心病患者,行^99mTc-N-NOET运动负荷和再分布心肌灌注显像,所有患者行冠状动脉造影检查。结果在42例患者中,26例冠状动脉造影显示有冠状动脉狭窄病变,其中单支病变10例,二支病变7例,三支病变9例.^99mTc-N-NOET心肌显像检出心肌缺血或心肌梗死21例,未检出异常5例;16例冠状动脉造影正常患者,^99mTc-N-NOET心肌显像正常14例,异常2例.^99mTc-N-NOET心肌灌注显像诊断冠心病的敏感性为81％、特异性为88％、阳性预测值91％,阴性预测值74％,预测准确性为83％。诊断单支、二支和三支冠状动脉病变的敏感性分别为60％（6／10）、86％（6／7）、100％（9／9）。42例均无干扰心肌分辨的肺、肝重度摄取增高者。15min运动负荷显像肺脏摄取高,尤以冠状动脉狭窄患者增高明显。结论 ^99mTc-N-NOET心肌灌注显像检测冠心病敏感性、特异性较高,早期显像肺摄取增加与有意义的冠状动脉病变有关。     

Comparison of stress/rest myocardial perfusion tomography, dipyridamole and dobutamine stress echocardiography for the detection of coronary disease in hypertensive patients with chest pain and positive exercise test.

OBJECTIVES: Although different noninvasive tests have been proposed for detecting coronary artery disease (CAD) in patients with hypertension and chest pain symptoms, the relative performance of the available techniques has not been systematically assessed. BACKGROUND: Patients with hypertension frequently complain of chest pain and exhibit ischemic-like ST segment changes on the exercise electrocardiogram (ECG). However, the specificity of such changes for predicting significant CAD is very low, because these patients often exhibit a normal coronary angiogram. METHODS: In 101 patients with hypertension, chest pain and positive exercise ECG, we performed stress/rest myocardial single photon emission computed tomography with 99mTc-MIBI, dipyridamole and dobutamine stress echocardiography and coronary angiography. All patients had normal global ventricular function and 57 had left ventricular hypertrophy. All were kept on ACE inhibitors during the study period. RESULTS: No patients had significant side effects during perfusion scintigraphy. Dose-limiting side effects were observed in five patients with dipyridamole and in seven patients with dobutamine. Only 56% of study patients exhibited significant CAD. Sensitivity, specificity, accuracy, positive and negative predictive values were, respectively, 98%, 36%, 71%, 67% and 94% for perfusion scintigraphy, 61%, 91%, 74%, 90% and 64% for dipyridamole and 88%, 80%, 84%, 85% and 83% for dobutamine stress echocardiography. CONCLUSIONS: This study shows that stress echo in patients with hypertension yields a satisfactory diagnostic accuracy for identifying significant epicardial CAD. Our results indicate that dobutamine might be superior to dipyridamole. The low specificity of myocardial scintigraphy probably relates to the fact that this method traces perfusion abnormalities, not necessarily caused by epicardial CAD, possibly due to microvascular disease and not causing obvious wall motion abnormalities.     

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.     

Functional assessment with electrocardiographic gated single-photon emission computed tomography improves the ability of technetium-99m sestamibi myocardial perfusion imaging to predict myocardial viability in patients undergoing revascularization

This study evaluates the use of electrocardiographic (ECG) gated single-photon emission computed tomographic (SPECT) myocardial perfusion imaging for the prediction of viability in patients undergoing revascularization, who have coronary disease and left ventricular dysfunction. Fifty patients underwent technectium-99m (Tc-99m) sestamibi ECG gated SPECT imaging preoperatively at rest and 1 week after revascularization, whereas 36 (72%) also underwent imaging 6 weeks after revascularization. Images were interpreted by the consensus of 3 experienced readers without knowledge of patient identity or time of imaging (pre- or postrevascularization) for perfusion and wall motion using a 17-segment model. Results of perfusion alone were compared with perfusion and wall motion combined. One hundred five coronary artery territories were revascularized, 96 of which were viable and 9 nonviable. Perfusion alone predicted 87 to be viable and 18 nonviable (sensitivity 86%, specificity 55%, positive predictive value 95%, negative predictive value 28%, and overall accuracy 85%). Perfusion and wall motion combined identified 95 territories to be viable (sensitivity 95%; p <0.025; specificity 55%, positive predictive value 96%, negative predictive value 50%, and overall accuracy 91%; p <0.05). Thus, Tc-99m sestamibi ECG gated SPECT myocardial perfusion imaging at rest allows assessment of both perfusion and wall motion, which significantly improves the sensitivity and overall accuracy for determination of viability in comparison with perfusion alone.     

腺苷负荷试验心肌灌注显像诊断冠心病的临床价值

目的　评价腺苷负荷试验心肌灌注显像诊断冠心病的准确性。方法　对 89例临床疑诊冠心病患者 ,分别静脉注射腺苷 ,剂量为 14 0 μg·kg-1·min-1,用药时间 6min(总剂量为 0 8mg/kg) ,注射过程中 ,行心电监测 ,观察患者的症状、血压和心率 ,于注射腺苷 3min末 ,静脉注射核素显像剂99mTc MIBI 92 5MBq ,1h后行心肌灌注断层显像 ,若显像异常 ,次日行静息心肌显像。所有患者行冠状动脉造影。结果　在 89例患者中 ,31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 10例 ,二支病变 11例 ,三支病变 10例。累及左前降支 2 8支 ,左回旋支 18支 ,右冠状动脉 16支 ,左主干 2支。腺苷负荷试验心肌灌注显像诊断冠心病的敏感性为 71%、特异性为 91%、阳性预测值81%、阴性预测值 84 %、准确性为 84 %。诊断单支、二支和三支冠状动脉病变患者的敏感性分别为5 0 %、73%、90 %。腺苷负荷试验心肌灌注显像判断血管病变的敏感性 77%、特异性 96 %、准确性 92 %。结论　腺苷负荷心肌灌注显像诊断冠心病敏感性及特异性均较高 ,具有重要的临床应用价值。