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1.
运动负荷核素心肌灌注显像对冠心病心肌缺血的诊断准确性高。为明确冠心病心肌缺血诊断,2006年1月~2006年12月对81例有不典型胸痛的患者分别行运动负荷核素心肌灌注显像和冠状动脉(简称冠脉)造影检查,以评价运动负荷核素心肌灌注显像诊断不典型胸痛患者心肌缺血的临床价值。  相似文献   

2.
目的 探讨MR灌注成像和SPECT检测存活心肌的价值.方法 对30例临床诊断为急性心肌梗塞的患者(共计510个心肌节段),进行MR心肌灌注扫描检查,包括MR心肌灌注首过时相及MR心肌灌注延迟扫描.将MR扫描结果与单光子发射计算机体层显像(SPECT)结果进行对照,所有病例均行X线冠状动脉造影检查证实.结果 MR心肌灌注首过时相扫描发现198个节段呈低灌注缺血改变,312个节段灌注正常;MR心肌灌注延迟扫描发现56个节段造影剂潴留呈梗死改变,454个节段为活性心肌.X线冠状动脉造影检查显示49支冠状动脉主干或其主要分支狭窄.SPECT检出的梗死节段比MR心肌灌注扫描检出的节段少,二者的差异具有统计学意义.结论 MR心肌灌注扫描对存活心肌的诊断、预后评估具有重要意义.  相似文献   

3.
目的 探讨运动试验同时行^18F-脱氧葡萄糖(FDG)心肌代谢和^99Tc^m-甲氧基异丁基异腈(MIBI)心肌灌注显像判断心肌缺血的可行性和诊断价值.方法 26例既往无心肌梗死病史的确诊或怀疑冠心病患者,在运动试验高峰或出现终止指标时注射^99Tc^m-MIBI和^18F-FDG,进行心肌灌注和代谢显像,随后进行静息^99Tc^m-MIBI心肌灌注显像以及冠状动脉造影.比较运动^18F-FDG心肌代谢显像和^99Tc^m-MIBI心肌灌注显像及冠状动脉造影结果.结果 22例有1支及其以上冠状动脉狭窄≥50%的患者中,18例出现血流灌注异常,灵敏度为82%,20例患者有明显^18F-FDG摄取,灵敏度为91%,两者比较差异无显著性(x^2=1.497,P=0.338).静息^99Tc^m-MIBI心肌灌注显像示完全(12例)或部分(3例)可逆性心肌灌注缺损(心肌缺血)的患者同时行运动试验^99Tc^m-MIBI心肌灌注、^18F-FDG心肌代谢显像,表现为血流灌注减低的心肌节段^18F-FDG摄取增加.与冠状动脉造影对比,22例患者共51个病变血管(管腔狭窄≥50%)支配的心肌节段中,运动试验^99Tc^m-MIBI心肌灌注显像发现了25个节段,灵敏度为49%,而运动^18F-FDG心肌代谢显像发现了34个节段,灵敏度为67%(x^2=7.30,P=0.008).结论 运动试验引起心肌缺血可以进行^18F-FDG心肌代谢显像.且与单纯运动/静息心肌灌注显像比较,同时行运动试验^99Tc^m-MIBI心肌灌注和^18F-FDG心肌代谢显像对诊断局部缺血心肌节段有更高的准确性.  相似文献   

4.
目的:探讨双嘧达莫负荷201Tl心肌灌注显像结合肺/心比值(LHR)测定技术在评价冠脉造影阴性心绞痛患者心肌缺血中的诊断价值.材料和方法:46例有典型心绞痛症状、同期冠状动脉造影检查均未发现异常的患者,和25例正常者接受双嘧达莫负荷试验下早期与延迟相201Tl心肌灌注显像,进行心肌节段缺血计分并测定LHR值.患者同期接受心电图超声心动图检查以供对照.结果:46例心绞痛患者心肌缺血指数均呈异常,提示存在心肌缺血,25例正常者心肌灌注显像均正常;两组LHR值间存在显著差异(P<0.01).心肌缺血定位(前、侧、间、后下壁)、单或多节段缺血、左室心肌肥厚与否对LHR值无影响(P>0.05);高血压组与无高血压组在LHR值上存在显著差异(P<0.01).结论:双嘧达莫负荷试验下201T1心肌灌注显像结合LHR测定,兼具灌注显像的定性、定位优势和LHR测定对血流动力学、左室功能的定量优势,在冠脉造影阴性的心肌缺血评价中具有重要临床价值.  相似文献   

5.
目的评价腺苷和运动负荷心肌灌注显像诊断不典型胸痛患者心肌缺血的价值。方法不典型胸痛患者67例行腺苷负荷心肌灌注显像,81例行运动负荷心肌灌注显像,结果分别与冠状动脉(简称冠脉)造影比较,得到显像诊断冠心病心肌缺血的灵敏度、特异性和准确性。结果腺苷负荷心肌灌注显像组67例中,23例冠脉造影有狭窄病变,腺苷负荷心肌灌注显像检出可逆性灌注异常即诊断心肌缺血16例,44例冠脉造影阴性者中,腺苷心肌灌注显像正常41例。腺苷负荷心肌灌注显像诊断冠心病心肌缺血的灵敏度为70%,特异性93%,准确性85%。运动负荷心肌灌注显像组81例中,31例冠脉造影阳性,运动负荷心肌灌注显像检出心肌缺血22例,50例冠脉造影阴性者中,运动负荷心肌灌注显像正常48例。运动负荷心肌灌注显像诊断冠心病心肌缺血的灵敏度为71%,特异性96%,准确性86%。结论腺苷或运动负荷心肌灌注显像出现可逆性灌注异常对诊断不典型胸痛患者冠心病心肌缺血有重要意义。  相似文献   

6.
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。  相似文献   

7.
介绍了核素心肌灌注、心肌代谢、核素心室显像在缺血性心肌病(CAD-CM)和扩张性心肌病(DCM)鉴别诊断中的意义。扩张性心肌病患者心肌灌注显像多表现为放射性分布不均匀,无灌注缺损,代谢显像常与灌注显像一致,核素心室显像表现为弥漫性的室壁运动异常。缺血笥心肌病患者心肌灌注显像多表现严重的灌注异常,有灌注缺损且呈节段性分布,灌注与代谢显像不匹配多见,核素心室显像表现为节段性的定壁运动减低。  相似文献   

8.
 目的 探讨颈动脉超声、核素心肌灌注显像对冠心病的诊断价值.方法 对88例疑有冠心病者,以冠状动脉造影结果 作为诊断标准, 进行颈动脉超声检查和核素心肌灌注断层显像两种检查,并将结果 进行对比分析.结果 颈动脉超声诊断冠心病的敏感性为65.5%,特异性为73.3%.核素心肌灌注显像诊断冠心病的敏感性为86.2%,特异性为66.7%.结论 颈动脉超声结合核素心肌灌注显像诊断冠心病,敏感性与特异性较高,对冠心病的无创性诊断具有重要价值.  相似文献   

9.
介绍了核素心肌灌注、心肌代谢、核素心室显像在缺血性心肌病(CAD-CM)和扩张性心肌病(DCM)鉴别诊断中的意义。扩张性心肌病患者心肌灌注显像多表现为放射性分布不均匀,无灌注缺损,代谢显像常与灌注显像一致,核素心室显像表现为弥漫性的室壁运动异常。缺血笥心肌病患者心肌灌注显像多表现严重的灌注异常,有灌注缺损且呈节段性分布,灌注与代谢显像不匹配多见,核素心室显像表现为节段性的定壁运动减低。  相似文献   

10.
目的用201Tl与99Tcm-4,9-二氮-3,3,10,10-四甲基十二烷-2,11-二酮肟(HL91)同时评价心脏病患者心肌灌注与乏氧.方法22例心脏病患者及9例临床诊断正常者行10 min、3和24 h延迟201Tl与99Tcm-HL91双核素心肌显像,用5分法评价图像质量,用17节段法分析201Tl显像缺损与乏氧显影心肌节段.结果双核素显像中99Tcm-HL91显像图质量不如201Tl(P<0.01);80.85%(38/47个节段)的急性心肌梗死患者201Tl灌注缺损心肌节段在99Tcm-HL91显像中显影,乏氧显影心肌节段数明显多于201Tl灌注缺损节段数;陈旧性心肌梗死201Tl、99Tcm-HL91均不显影的符合率为85.71%.结论201Tl与99Tcm-HL91双核素心肌显像能同时提供判断心肌血流灌注与乏氧的信息.  相似文献   

11.
目的 评价MR多技术扫描和心肌声学造影(MCE)在检测心肌灌注、判断心肌存活中的作用。资料与方法 应用MR多技术扫描对36例冠心病患者进行检查,并将结果与冠状动脉造影、MCE结果对照。结果 共有81支冠状动脉狭窄≥70%,狭窄的冠状动脉供血区域为334个(57.99%)节段。MR心肌灌注扫描见268个(46.53%)节段呈缺血改变,MR心肌活性扫描见83个(14.4l%)节段心肌梗死。以冠状动脉造影结果为标准,MR心肌灌注扫描的敏感性为80.2%,特异性为100%,总符合率为88.5%,Kappa值为0.773。定性MCE检查共有202个(35.07%)节段呈缺血改变。以冠状动脉造影结果为标准,定性MCE的敏感性为60.5%,特异性为100%,总符合率为77.1%,Kappa值为0.563。MR心肌灌注扫描所发现的缺血节段比狭窄冠状动脉的供血节段少但无统计学意义(P=0.468),MCE所发现的缺血节段比狭窄冠状动脉的供血节段少(P=0.000);MR心肌灌注扫描检出缺血节段比MCE检出的多(P=0.000)。结论 MR多技术扫描可清晰显示心肌缺血或梗死的位置、程度,可重复性好,与冠状动脉造影结果的一致性较高。MCE为临床提供了元创、可重复地准确测定心肌缺血的新方法,但其评价方法具有一定主观性且低估心肌缺血的范围,检查者的经验和检查方法在一定程度上影响其准确性。  相似文献   

12.
DETECTION OF MYOCARDIAL ISCHEMIA BY ELECTRON BEAM CT: Experimental studies   总被引:5,自引:0,他引:5  
Purpose: To determine if contrast-enhanced electron beam CT (EBCT) can detect areas of acute myocardial ischemia, and if pharmacological stress testing improves the diagnostic accuracy of EBCT.Material and Methods: We injected 0.5 ml/kg and 1.0 ml/kg b.w. of iopromide at a rate of 4 ml/s into the right atrium of 5 ventilated female minipigs at rest and after occlusion of the left anterior descending (LAD) coronary artery. Both ventricles were examined at six short axis levels with an EBCT unit. Myocardial perfusion was calculated from the time-density curves of four left ventricular myocardial segments and the aorta. We also tested the effect of the contrast agent on myocardial density after i.v. administration of 0.6 mg/kg dipyridamole before and after LAD occlusion.Results: At rest, the contrast agent increased myocardial density by 28±2 HU, corresponding to a myocardial perfusion estimate of 67±7 ml/min/100 g. After dipyridamole, myocardial density increased by 29±4 HU. Following occlusion of the LAD, anteroseptal myocardium displayed 10±4 HU density increase. The area of non-enhancement corresponded to ischemic myocardium in stained pathologic sections.Conclusion: Contrast-enhanced stress EBCT can be used to detect areas of myocardial ischemia, and EBCT stress perfusion imaging may be necessary to consistently differentiate ischemic from non-ischemic myocardial tissue.  相似文献   

13.
目的比较电子束CT(EBCT)检查冠状动脉钙化(CAC)及核素心肌灌注显像(MPI)评价冠心病(CHD)的价值。材料与方法本组50例均为临床疑诊或确诊为CHD患者。所有患者均行EBCT、MPI及冠状动脉造影。结果40例患者共84支血管冠状动脉造影证实有明显的冠状动脉病变(CAD)(狭窄>50%),其中14例为单支病变,8例为双支病变,18例为三支病变,另有10例冠状动脉造影正常。EBCT预测CAD的敏感性、特异性及准确性为83%、80%及82%,MPI预测CAD的敏感性、特异性及准确性分别为85%、80%及84%,EBCT与MPI的结果间无显著性差异(P>0.05)。CAC血管供血区出现心肌缺血者达65%。结论CAC是预测CAD的有价值指标。在有症状的人群中EBCT检出CAC预测CAD的敏感性、特异性及准确性与MPI相似。有症状人群中检出CAC患者多有心肌缺血或梗死,因此为早期诊断冠心病,应对无症状人群进行筛选。  相似文献   

14.
Background  There have been limited data regarding the value of gated single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) for the detection of left main coronary artery disease (CAD). Methods and Results  We studied 101 patients with angiographic left main CAD (≥50% stenosis) and no prior myocardial infarction or coronary revascularization who underwent gated exercise or adenosine stress technetium 99m sestamibi SPECT MPI. By perfusion assessment alone, high-risk disease with moderate to severe defects (>10% myocardium at stress) was identified in only 56% of patients visually and 59% quantitatively. Absence of significant perfusion defect (≥5% myocardium) was seen in 13% of patients visually and 15% quantitatively. However, by combining visual perfusion data and nonperfusion variables, especially transient ischemic dilation, 83% of patients were identified as high risk. Conclusions  The findings of this study demonstrate that assessment of perfusion data alone by visual or quantitative SPECT MPI analysis underestimates the magnitude of left main CAD. The combination of perfusion and nonperfusion abnormalities on gated MPI identifies high risk in most patients with left main CAD. This study was presented in part at the American College of Cardiology 56th Annual Scientific Session, March 24–27, 2007, New Orleans, La. This work was supported in part by grants from Bristol-Myers Squibb Medical Imaging, Billerica, Mass, and Astellas, Deerfield, Ill.  相似文献   

15.
Recent studies have shown that vasodilator-induced ischemic electrocardiographic (ECG) changes have incremental prognostic value over normal SPECT myocardial perfusion imaging (MPI) and identify patients at higher risk for cardiac events. The prognostic value of vasodilator-induced ischemic ECG changes in the setting of normal PET MPI has yet to be determined. We sought to determine the prognostic importance of dipyridamole-induced ischemic ECG changes in patients with normal 82Rb PET myocardial perfusion images. METHODS: Between 2000 and 2003, 2,029 consecutive patients undergoing dipyridamole stress 82Rb PET at the University of Ottawa Heart Institute were evaluated. Patients with normal PET MPI and interpretable ECGs were enrolled. Electrocardiograms were assessed for ST depression or elevation and patients were categorized into those with and without dipyridamole-induced ischemic ECG changes. Images were graded using the 17-segment model. Follow-up information was obtained by telephone interview, from hospital records, or from treating physicians. All cardiac events (cardiac death, nonfatal myocardial infarction [MI], percutaneous coronary intervention, coronary artery bypass grafting, or angiography) were verified with hospital records. RESULTS: Of the 629 enrolled patients with normal PET MPI, 72 patients had dipyridamole-induced ischemic ECG changes. There was no significant difference between the 2 groups in the combined endpoint (cardiac death, nonfatal MI, and revascularization) at follow-up (mean +/- SD, 27.1 +/- 13 mo). There were no cardiac deaths in either group. One (1.4%) patient with ischemic ECG changes had a nonfatal MI (0.6% annual event rate). Two (2.8%) patients with ischemic ECG changes required revascularization compared with 11 (2.0%) in the nonischemic ECG group. CONCLUSION: Normal 82Rb PET confers an excellent prognosis regardless of dipyridamole-induced ST depression.  相似文献   

16.
禹晖  张金赫  尹吉林   《放射学实践》2011,26(12):1320-1322
目的:通过对心肌灌注显像(MPI)与心脏双源CT(DSCT)检查结果进行对比分析,探讨两者对冠心病的临床诊断价值.方法:对38例拟诊为冠心病的患者行MPI及心脏DSCT检查;分别对MPI图像及DSCT图像进行分析处理,其中29例经冠状动脉造影(CAG)证实为冠心病.结果:DSCT显示有29例冠脉狭窄程度>50%,其中大...  相似文献   

17.
Myocardial SPECT may be useful for assessment of the therapeutic effects and the mechanisms of cardiac regeneration medicine. We aimed to assess first the feasibility and the short-term safety of autologous bone marrow-derived mononuclear cell transplantation (BMCT) into the ischemic myocardium in patients who undergo off-pump coronary artery bypass surgery (OPCAB). In addition, we aimed to assess our hypothesis that the BMCT may help ameliorate myocardial perfusion in patients with ischemic heart disease (IHD) using myocardial perfusion scintigraphy. METHODS: We performed BMCT in 10 patients with IHD during OPCAB. Cells for BMCT were collected by intraoperative bone marrow aspiration or by preoperative cellular apheresis after pretreatment with granulocyte colony-stimulating factor. After OPCAB was performed in all graftable ischemic areas, a total of 3.4 +/- 1.2 x 10(9) mononuclear cells, including 5.2 +/- 1.6 x 10(6) CD34-positive (CD34(+)) cells, were injected into ungraftable ischemic myocardial areas. Dipyridamole-stress and resting (99m)Tc myocardial SPECT was performed before and 1 mo after the procedures. RESULTS: BMCT was performed safely in all patients. Compared with before treatment, myocardial (99m)Tc tracer uptake on the dipyridamole-stress image increased similarly in BMCT- and OPCAB-treated areas, whereas tracer accumulation at rest did not change in all myocardial areas. The improvement of myocardial perfusion was not correlated with the total number of mononuclear cells transplanted. However, it was positively correlated with the number of transplanted CD34(+) cells: (99m)Tc tracer uptake after/before BMCT (ratio) = 1.091 x (CD34(+) cell number [x10(6)])(0.074) (r(2) = 0.48, P < 0.05), although new development of coronary vessels was not documented cineangiographically. Myocardial histopathology in 2 of 3 autopsy cases revealed coronary angiogenesis in the areas corresponding to the sites of BMCT. CONCLUSION: The present study demonstrates the feasibility of BMCT combined with OPCAB. This therapy improves myocardial perfusion possibly via CD34-related development of coronary microvessels.  相似文献   

18.
目的 评价双源双能量CT(DECT)成像诊断猪急性心肌缺血再灌注损伤的可行性和准确性.方法 8只猪通过开胸结扎冠状动脉左前降支(LAD)或第一对角支(D1)建立再灌注损伤模型,术后行DECT心肌灌注成像扫描.检查结束后立即处死动物,取出心脏,进行氯化三苯基四氮唑(TTC)染色,分析心肌缺血再灌注损伤范围.以病理结果为参照,测量损伤区、非损伤区的CT值以及损伤区面积.将左心室壁分为17个节段,确定DECT心肌灌注碘图、DECT(140、100和平均加权120 kV)3组图像和大体病理上心肌损伤的节段数.以病理结果为金标准分别评价DECT心肌灌注碘图、3组图像显示心肌损伤的敏感性、特异性和一致性.利用方差检验分析损伤区和非损伤心肌不同管电压条件的CT值、大体病理和DECT 3组图像所测量损伤区重量的差异.结果 8只猪DECT心肌灌注碘图见心尖前壁、心尖间隔灌注稀疏甚至缺损,DECT 3组图像中再灌注损伤区CT值均较正常心肌明显降低.与病理金标准对照,DECT心肌灌注碘图诊断再灌注损伤的敏感性、特异性分别为85.2% (23/27)、86.2% (94/109),Kappa值为0.62;DECT3组图像的敏感性、特异性和Kappa值:140 kV组分别为88.9% (24/27)、92.7% (101/109),0.76;100 kV组分别为85.2% (23/27)、89.0%(97/109),0.67;平均加权120 kV组分别为88.9% (24/27)、91.7% (100/109),0.74.DECT 3组图像测量损伤心肌重量与大体病理所测值之间差异无统计学意义(F=0.419,P=0.741).结论 DECT心肌灌注成像可用于检测猪急性心肌缺血再灌注损伤,与病理诊断一致性较好.  相似文献   

19.
In patients with coronary artery disease, the distinction between scar and viable myocardium by means of myocardial perfusion imaging (MPI) sometimes can be difficult because of the equivocal meaning of fixed perfusion defects. In this study we examined whether addition of a 99mTc-sestamibi infusion study to the standard MPI could provide extra information regarding the fixed defects. Thirty-seven patients underwent standard MPI and an extra SPECT study in which 99mTc-sestamibi was given as a prolonged constant infusion. Of 324 myocardial segments available for analysis, 134 had fixed or resting perfusion abnormalities on standard MPI studies, of which 25% (33/134) in 12 patients showed partial improvement in the perfusion pattern whereas in 6% (8/134) the improvement was very significant in infusion studies. In 19 patients who were also examined with dobutamine echocardiography, 13 showed concordance between echocardiography and infusion MPI. This study suggests that infusion MPI may provide complementary information to the conventional scintigraphy with regard to interpretation of standard myocardial perfusion scans with fixed defects.  相似文献   

20.
目的探讨不同校正方法对SPECT/CT心肌灌注显像图像质量及半定量结果的影响。资料与方法回顾性分析60例99Tcm-甲氧基异丁基异腈(99Tcm-MIBI)运动负荷及静息心肌灌注显像患者,均进行CT衰减校正(CTAC)和双能窗散射校正(SC)。分别重建CTAC、SC、CTAC+SC以及无衰减校正和散射校正(NOC)图像。利用靶心图获得不同校正状态左心室各壁段的放射性计数百分比,以及运动负荷和静息图像灌注缺损半定量评分,比较不同校正状态下缺血心肌图像质量和半定量结果的差异。结果运动负荷显像左心室心尖部、下后壁、间壁、侧壁放射性计数百分比在不同校正方法间差异有统计学意义(P均<0.05)。负荷总体灌注不足率、负荷灌注总评分、静息-负荷差异总评分在不同校正方法间差异有统计学意义(P均<0.05),其在SC图像中明显高于NOC图像(P均<0.05),在CTAC+SC图像中明显高于CTAC图像(P均<0.01)。目测比较SC图像缺血心肌的稀疏程度明显高于NOC图像,CTAC+SC图像明显高于CTAC图像,其中以CTAC+SC图像对缺血部位的显示最为清晰。比较不同校正状态缺血心肌放射性分布评分,缺血程度为3分的比例在SC图像中明显高于NOC图像(X^2=4.953,P=0.026),在CTAC+SC图像中明显高于CTAC图像(X^2=7.216,P=0.007)。结论不同校正状态下左心室缺血心肌图像质量及半定量结果出现明显差异,SC能显著改善缺血心肌的显示,尤其在CTAC图像中更为显著。  相似文献   

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