99Tcm-MIBI与18F-FDG双核素同时采集法心肌显像检测存活心肌

目的 评价辨99Tcm-甲氧基异丁基异腈(MIBI)与18F-脱氧葡萄糖(FDG)双核素同时采集法心肌显像(DISA SPECT)检测存活心肌的临床价值.方法 21例经彩超检查证实存在左室壁节段运动障碍的冠心病患者,进行DISA SPECT、冠状动脉造影(CAG)及经皮冠状动脉介人治疗(PCI),对所有狭窄病变行完全血运重建术.参照美国超声心动图学会16节段划分法获得心肌各运动异常节段DISA SPECT图像,并对心肌存活情况进行判定.DISA SPECT图像用目测半定量法分析.术后1,3和6个月时复查心脏超声,以冠状动脉血运重建后室壁节段收缩功能改善为判断存活心肌的"金标准",根据诊断试验四格表评价DISA SPECT检测存活心肌的价值.结果 21例冠心病患者共获得符合条件的室壁运动异常节段156个,根据"金标准"判断其中105个为存活心肌,51个为非存活心肌,DISA SPECT检测存活心肌的灵敏度、特异性、阳性预测值、阴性预测值、准确性分别是93.3%(98/105)、82.4%(42/51)、91.6%(98/107)、85.7%(42/49)、89.7%(140/156).结论 DISASPECT目测半定量法检测存活心肌有较高的临床价值.

99Tcm-MIBI and 18F-FOG dual isotope simultaneous acquisition SPECT in determination of myocardial viability

Objective Viable myecardium is important to patients with coronary artery diseage.The obiecfive of this study was to evaluate the value of dual-isotope simultaneous acquisition SPECT(DISA SPECT)with 99Tcm-methoxyisobutylisonitrile (MIBI) and 18F-fluorodeoxyglueose (FDG) in detecting viable myocardium(VM).Methods Twenty-one patients with regional wall motion abnomudities(RWMA) based on routine echocardiography underwent DISA-SPECT,coronary angiography and percutaneous coronary intervention(PCI).Imaging and analysis of the left ventrieular myocardial perfusion status were performed according to the 16-segment models proposed by American Society of Echocardiography.The wall motion of every LV segment was observed by echocardiography after 1,3,6 months.The images of DISASPECT were analyzed semi-quantitatively.The"gold standard"for true viability was improvement of wall motion of the vertricular segment after PCI.Results There were 105 viable myocardial segments and 51 non-viable myocardial segments according to the"gold standard"criterion.The sensitivity,specificity.positive predict value,negative predict value and accuracy of DISA-SPECT in detecting viable myoeardium were 93.3%(98/105),82.4%(42/51),91.6%(98/107),85.7%(42/49),89.7%(140/156),respectively.Conclusion DISA-SPECT is a valuable technique to detect viable myocardium in patients with coronary artery disease.