99Tcm-替曲膦在冠心病诊断中的应用

目的 探讨99Tcm-替曲膦(TF)在CHD诊断中的应用价值.方法 回顾性分析2009年10月至2011年4月疑诊CHD并行99Tcm-TF或99Tcm-MTBI腺苷负荷-静息MPI的患者各40例,比较2种放射性药物心肌显像的心肺摄取比(H/L).行99Tcm-TF显像的患者显像前后3个月内均行CAG,以冠状动脉狭窄≥50％为标准计算99Tcm-TF显像对CHD的诊断效能.对99Tcm-TF及99Tcm-MIBI H/L间差异行配对t检验,率的比较行x2检验.结果 99Tcm-TF心肌静息及负荷显像H/L分别为6.73±1.21及6.94±1.69,99Tcm-MIBI显像的相应值分别为6.58±1.94及6.64±1.81,2种显像方法H/L间差异无统计学意义(=0.41和0.78,P均＞0.05),99Tcm-TF心肌静息及负荷显像H/L差异亦无统计学意义(t=0.69,P＞0.05). 40例患者中99Tcm-TF显像阳性24例(60.0％),对应病变血管45支,其中LAD 20支,LCX 11支,RCA 14支.CAG阳性23例(57.5％,23/40),对应病变血管42支(LAD19支,LCX 12支,RCA 11支).99Tcm-TF负荷-静息MPI的灵敏度、特异性、准确性、阳性预测值及阴性预测值分别为87.0％(20/23)、76.5％(13/17)、82.5％(33/40)、83.3％(20/24)及81.2％(13/16).以病变血管计,99Tcm-TF MPI对LAD、LCX及RCA血管病变诊断的灵敏度分别为89.5％(17/19)、83.3％(10/12)及90.9％(10/11)；阳性预测值分别为85.0％(17/20)、90.9％ (10/11)及71.4％(10/14).99Tcm-TF显像对不同血管病变的灵敏度和阳性预测值差异均无统计学意义(x2=0.377和1.789,P均＞0.05).结论 从H/L可知,99Tcm-TF显像图像质量与99Tcm-MIBI显像接近；99Tcm-TF负荷-静息MPI是诊断CHD的可靠方法.

Clinical application of ^99Tc^m-tetrofosmin in diagnosing patients with coronary heart diesase

Objective To evaluate the diagnostic value of ^99Tc^m-tetrofosmin （TF） stress-rest MPI in detecting CHD. Methods Eighty patients with suspected CHD who had stress-rest MPI from October 2009 to April 2011 were retrospectively analyzed. Forty underwent 99Tem-TF （group A） and 40 received Clinical application of ^99Tc^m-MIBI （group B） stress-rest MPI. Heart/lung （H/L） ratios of these two groups were compared. CAG was performed on group A patients 3 months before and after MPI. Stenosis of more than 50% in CAG was used as a standard to evaluate the diagnostic efficiency of Clinical application of ^99Tc^m-TF MPI. Paired t test andX2 test were used to compare the data. Results H/L ratios of rest and stress from Clinical application of ^99Tc^m-TF images were 6.73 ± 1.21 and 6. 94 ± 1.69, while those from Clinical application of ^99Tc^m-MIBI images were 6.58 ±1.94 and 6.64 ±1.81, respectively. There was no difference between ^99Tc^m-TF and ^99Tc^m-MIBI imaging in both rest and stress （t =0.41,0.78, both P 〉 0.05 ）. There was no difference between H/L ratios from stress and rest Clinical application of ^99Tc^m-TF imaging （t = 0. 69, P 〉 0. 05）. Twenty-four patients who underwent Clinical application of ^99Tc^m-TF imaging had abnormal perfusion （60.0% , 24/40） , including 20 LAD, 11 LCX and 14 RCA. Twenty-three among these 40 patients had abnormal CAG results （57.5%, 23/40） , including 19 LAD, 12 LCX, and 11 RCA. The sensitivity, specificity, accuracy, posi- tive predictive value and negative predictive value of Clinical application of ^99Tc^m-TF stress-rest MPI were 87.0% （ 20/23 ） , 76. 5% （ 13/17）, 82.5% （33/40）, 83.3% （20/24） and 81.2% （ 13/16）, respectively. The sensitivitiesof Clinical application of ^99Tc^m-TF stress-rest MPI for detection of LAD, LCX and RCA were 89.5% （17/19）, 83.3% （10/12） and 90.9% （ 10/11 ）, respectively, and positive predictive values were 85.0% （ 17/20）, 90.9% （ 10/11 ） and 71.4% （10/14）, respectively. There was no significant difference for sensitivity and positive predictive value of ^99Tc^m-TF MPI among different vessels （X2 = 0. 377 and 1. 789, both P 〉 0.05 ）. Conclusions Clinical application of ^99Tc^m-TF MPI has comparative imaging quality to ^99Tc^m-MIBI MPI. Clinical application of ^99Tc^m-TF stress-rest MPI is a reliable method for detecting CHD.