99mTc-MIBI门控心肌断层显像在冠状动脉支架术后的临床价值

目的:探讨99mTc-甲氧基异丁基异腈(MIBI)门控心肌断层显像(G-MPI)在冠状动脉支架术后疗效评价、判断再狭窄以及预后评估的临床价值。方法:78例患者,冠状动脉支架术后3～12个月内均行G-MPI,其中31例有术前对照。33例复查冠状动脉造影(CAG)。随访13～24个月。结果:①31例复查G-MPI24例心肌灌注有改善,改善率为77.4%。②31例术后静息G-MPI所测左室射血分数(LVEF)较术前由(42.6±8.6)%上升至(49.7%±6.4)%,P<0.05;舒张末期容积(EDV)和收缩末期容积(ESV)分别由(158.2±55.3)ml、(92.6±44.9)ml明显下降到(133.9±39.9)ml、(71.2±28.7)ml,P均<0.01。③33例复查CAG患者,G-MPI对再狭窄诊断的敏感性、特异性、准确性为82.3%、85.0%、84.8%。④随访心脏事件发生率术后G-MPI灌注改善组(1.9%)与异常组(28.6%)之间有极显著差异(P<0.01)。结论:G-MPI对冠心病血运重建术后疗效评价、判断再狭窄以及预后评估具有重要的临床价值。     

不同采集模式门控心肌显像对左室功能参数测定的影响

目的 比较16帧和8帧采集模式下99Tcm-MIBI门控心肌显像对测定左室舒张末期容量(EDV)、收缩末期容量(ESV)、左室射血分数(LVEF)的影响.方法 91例患者,在相同条件下分别进行每个心动周期为16帧和8帧的门控采集.采用GS Quant软件分别计算出两种采集方法的EDV、ESV、LVEF,并进行比较.结果 (1)16帧和8帧门控采集对左室功能测定的重复性好,变异系数(CV)均小于2%.(2)16帧和8帧门控采集测定的EDV、ESV和LVEF分别为(68.2±20.5) ml、(20.9±11.9) ml和(71.3±9.2)%,(74.9±21.9) ml、(26.2±13.9) ml和(66.9±9.5)%.16帧测定的EDV、ESV值较8帧测定的小(P＜0.01),但其测定的LVEF 值较8帧高(P＜0.01).结论 16帧和8帧采集的门控心肌显像测定的EDV、ESV和LVEF值有很好的相关性.     

门控心肌灌注显像不同采集模式对左心室运动功能参数测定的影响

探讨每个心动周期8帧和16帧采集模式对门控心肌灌注显像(G-MPI)测定左心室运动功能参数的影响。前瞻性纳入2010年1月-2011年1月于四川大学华西医院核医学科拟行腺苷负荷/静息G-MPI的患者,利用共行成像技术,1次显像同时行16帧和8帧门控采集模式,采用Auto Quant软件分别计算两种采集模式所得的左心室舒张末期容积、收缩末期容积和射血分数(EF)。共48例患者的负荷/静息G-MPI纳入分析,其中男性29例,女性19例,平均年龄(51±16)岁。Bland-Altman一致性检验显示,负荷和静息状态下,16帧和8帧采集所得的EF值间的平均差值分别为3.13%(95%CI:5.93%～0.32%)和3.27%(95%CI:6.42%～0.12%)。16帧和8帧采集模式所获得的心肌缺血和(或)梗死患者的心室腔容积均较心肌灌注正常者大,相比EF值较心肌灌注正常者小。8帧和16帧采集模式不可相互替代来探测左心室EF。     

腺苷负荷~(99m)Tc-MIBI门控心肌灌注显像在老年人冠心病诊断中的临床价值

目的 探讨腺苷负荷99mTc-甲氧基异丁基异腈(MIBI)门控心肌灌注显像(G-MPI)在老年人冠心病(CAD)诊断中的敏感性、特异性及安全性,评价其对老年人CAD诊断的临床价值. 方法对414例老年可疑CAD患者(年龄≥60岁)行静息、腺苷负荷G-MPI,其中79例患者在2周内行冠状动脉造影(CAG)检查,并分为CAD组和非冠心病(N-CAD)组.结果 414例患者均完成腺苷负荷试验,288例患者出现29种轻度不良反应,最常见的有胸闷(47.9%)、气短(23.9%)、头晕(21%)、面红(8.5%),不良反应总发生率为69.6%(288/414).结论 腺苷负荷99mTc- MIBI G-MPI对诊断老年人CAD具有较高的敏感性、特异性.     

Correlation between transient ischemic dilatation (TID) and coronary artery disease in Saudi male patients

Objective

A high transient ischemic dilatation ratio (TID) for the left ventricle (LV) from a gated myocardial perfusion imaging (G-MPI) study is widely believed to be associated with significant coronary artery disease (CAD). We have investigated the relationship between TID and CAD for our male Saudi Arabian patient population.

Methods

In this retrospective study, all male Saudi Arabian patients who underwent a two-day G-MPI study using Tc99m MIBI during the year 2011 having a TID ⩾ 1.20 were included. Quantitative perfusion and gated parameters were obtained using Cedar Sinai’s AutoQuant software version 3.0, 2003, Means of summed stress scores, summed rest scores and summed difference scores (SSS, SRS, SDS, respectively), stress and rest ejection fraction (EF) were calculated. Visual interpretation was performed to classify the perfusion as normal, fixed, mixed (fixed and reversible defects), single reversible or multiple reversible defects. Coronary angiograms were assessed as normal with no CAD, single vessel, two-vessel or three-vessel disease. Correlations between the TID and other parameters were studied using analysis of variance (ANOVA) with IBM-SPSS version 20.

Results

A total of 52 male patients had a high TID of ⩾1.20 (mean 1.30 ± 0.13). Ten patients had a SSS of 0–3 and 16 were classified as normal by visual assessment. Stress EF (mean 50.4 ± 12%) was lower than the rest EF (mean 56.6 ± 12.8%) with the difference being statistically significant (Students paired t-test, p = 0.001).Angiography results were available in 44 patients, 3 having a normal angiogram, 24 having three vessel disease, 7 having two vessel disease and 10 having one vessel disease. Five patients with normal perfusion and SSS = 0–3 had CAD as seen on a coronary angiography. CAD on coronary angiography showed a significant correlation with perfusion abnormalities as assessed by visual interpretation (p = 0.002). TID showed a significantly correlation with both perfusion abnormalities (p = 0.009), as assessed by visual interpretation, and with Summed difference scores, SDS (p = 0.000).

Conclusion

A high TID on G-MPI was a very sensitive indicator of significant CAD. In patients with normal perfusion and high TID further workup is warranted.     

80例胸痛患者门控心肌显像的临床分析

目的进一步探讨负荷、静息门控心肌灌注显像在临床主诉胸痛、胸闷而疑诊冠心病患者中的临床应用。方法对80例有胸痛、胸闷不适主诉,临床疑诊冠心病的患者,行负荷及静息心肌灌注显像,分析显像的图像特点及对门控图像进行定量分析获得左心室射血分数（LVEF）。LVEF分为3组对比：①显像阳性与阴性的负荷比较;②显像阳性与阴性的静息比较;③所有负荷和所有静息的对比。结果对照冠脉造影结果,静息及负荷门控心肌灌注显像敏感性分别为81．1％和91．1％,特异性85．2％和88．9％,各组间LVEF差异无统计学意义。结论负荷或静息心肌灌注显像对胸痛、胸闷患者在冠心病诊断临床应用方面有很好价值;定量分析软件所得心功能指标有一定参考作用,但是尚不能作为诊断标准。