核素心肌灌注的定量及异质性分析对病毒性心肌炎的诊断价值

目的 探讨核素心肌灌注的定量及异质性分析诊断病毒性心肌炎（VMC）的价值。方法 回顾性分析接受^99mTc-MIBI心肌灌注显像的疑似VMC患者37例，其中18例临床诊断为VMC（VMC组），其余19例排除VMC的患者为非VMC组。使用QPS软件获得静息灌注总积分（SRS）及总灌注缺损值（TPD），计算靶心图放射性计数异质性参数节段靶心图变异系数（CV_s）和室壁靶心图变异系数（CV_w），比较2组心肌灌注各参数的差异。应用ROC曲线评价各参数对VMC的诊断效能。结果 VMC组心肌灌注以左心室前壁和下壁降低最显著（P均<0.05）；VMC组TPD、CV_s较非VMC组均明显增高（P均<0.05）；CV_s对VMC炎诊断效能最优（AUC=0.83，P<0.01），当CV_s阈值为10.5%时，其灵敏度为94.4%，特异度为73.7%。结论 心肌灌注异质性分析有助于VMC的诊断和鉴别诊断。

Value of quantitative and heterogeneous analysis of radionuclide myocardial perfusion in diagnosis of viral myocarditis

Objective To evaluate the value of quantitative and heterogeneous analysis of radionuclide myocardial perfusion in diagnosis of viral myocarditis (VMC). Methods ^99mTc-MIBI myocardial perfusion imaging data of 37 patients suspected with VMC were analyzed retrospectively. Eighteen patients were clinical diagnosed as VMC (VMC group) and 19 patients excluded VMC were served as non-VMC group. Summed rest score (SRS) and the total perfusion deficit (TPD) were obtained by using QPS software. Heterogeneity parameters of radioactive count (segmental coefficient of variation and ventricular wall coefficient of variation) were also calculated. Perfusion parameters were compared between the two groups, and the diagnostic value on discrimination of VMC patients was evaluated by ROC analysis. Results Compared with non-VMC group, myocardial perfusion in anterior and inferior walls decreased significantly in VMC group (all P<0.05); TPD and CV_s were significantly higher in VMC group (P<0.05). Efficiency of CV_s in diagnosis of VMC was best (AUC=0.83, P<0.01). When the threshold of CV_s was 10.5%, the diagnostic sensitivity was 94.4% and the specificity was 73.7%. Conclusion Heterogeneous analysis of myocardial perfusion is helpful for differential diagnosis of VMC.