~(99m)Tc-MIBI潘生丁负荷心肌灌注断层显像评价冠状动脉支架术后血管再狭窄的价值

目的: 通过对冠状动脉(简称冠脉)支架植入前后进行静息和潘生丁负荷99mTc-MIBI断层显像(R-MPTI、P-MPTI),以了解SPECT在支架置入术前筛选、术后再狭窄评价中的价值.材料和方法: 95例冠心病患者在冠状动脉介入治疗前、术后3～6个月行R-MPTI和P-MPTI.潘生丁最大剂量时注射740MBq99mTc-MIBI,1h后行心肌断层显象;24h后重复静态心肌显象.与术后复查冠脉造影(CAG)对比,分析心肌灌注显像对支架术后再狭窄的诊断效果.结果: 95例冠心病患者共有855个心肌血流灌注节段,术前R-MPTI发现196个心肌血流灌注缺损,P-MPTI发现351个.支架置入后R-MPTI检查发现62个心肌血流灌注缺损病变节段,P-MPTI检查发现145个心肌血流灌注缺损病变节段.术后CAG随访92例,18例(18/92,19.6%)共29支血管发生再狭窄.按再狭窄冠脉支数计算,R-MPTI、P-MPTI对再狭窄的诊断准确性、阳性预测值和阴性预测值分别为84.5%、92.6%; 59.5%、75.7%;95.7%、98.9%,所有指标均有显著差异(χ~2＝15.54)(P<0.01).结论: P-MPTI可以早期发现冠状动脉内支架术后再狭窄,诊断效率高于R-MPTI,有利于准确判断病情和指导治疗.

The Clinical Value of Dipyridamole Stress Myocardial Perfusion Imaging with ~(99m)Tc-MIBI in Diagnosing Restenosis After Coronary Artery Stent

Purpose The aim of this prospective study was to compare the diagnostic performances of rest and dipyridamole stress myocardial perfusion imaging using 99mTc-MIBI in detecting restenosis after coronary artery stent. Materials and Methods 95 clinically confirmed CAD patients receiving coronary stent underwent both rest and dipyridamole stess myocardial SPECT before and 3～6 months after the operation. Those suspected of restenosis underwent coronary angiography, and others were followed up clinically with myocardial perfusion imaging. Results Before stenting, perfusion defect were found in 196 and 351 segments among 855 segments/95 cases by rest and stress myocardial perfusion SPECT imaging(R-MPTI and P-MPTI) respectively. While after stenting, 18/92 cases were confirmed restenosis with CAG, involving 29 branches of coronary artery. The diagnostic accuracy, PPV, NPV of R-MPTI and P-MPTI, in light of CAG findings, were 84.5%、92.6%; 59.5%、75.7%;95.7%、98.9%,respectively. Conclusion The diagnostic performance of stress imaging in detecting restenosis after stenting was much higher than that of rest imaging alone, therefore it is necessary to have stress imaging in case restenosis was suspected after stenting.