SPECT心肌灌注显像和冠脉CTA对功能相关冠脉病变的诊断价值

目的分析单光子发射型计算机断层(SPECT)心肌灌注显像(MPI)和冠状动脉CT造影(CCTA)对功能相关冠脉病变(FRCAL)的诊断价值。方法收集我院心血管内科收治的85例疑诊冠心病(CAD)患者分别行CCTA和同机SPECT-MPI检查,根据CCTA结果判断冠脉狭窄程度,MPI图像采用17节段5分法分析,于CCTA/MPI融合影像上匹配出心肌血流灌注异常区域与供血冠脉病变情况,评估心肌灌注异常与供血冠脉狭窄程度的相关性。并于15日内行冠脉造影(CAG)诊治,分析CCTA/MPI融合影像诊断FRCAL的价值。结果本组患者中,心肌血流灌注正常7例,轻度、中度、重度灌注异常27例、37例、10例,无灌注4例;共发现灌注异常区87个,其平均血流灌注评分(2.56±0.80)分。87个心肌灌注异常区域中,有12个供血冠脉正常,剩余异常区域平均狭窄率为(66.78±10.25)%,心肌灌注异常越严重,其供血冠脉狭窄程度越高(P<0.05)。相关性分析显示心肌血流灌注评分与冠脉狭窄程度呈明显正相关(P<0.05)。CAG确诊存在FRCAL66例,以CAG为标准,CCTA/MPI融合影像诊断FRCAL的敏感度、特异度及准确率分别高达92.42%、84.21%、90.59%,明显高于二者单独诊断。结论心肌血流灌注异常与冠脉狭窄密切相关,CCTA/MPI融合影像可用于诊断FRCAL,继而可为CAD的精确诊断提供依据。

Diagnostic Value of SPECT Myocardial Perfusion Imaging and Coronary CTA for Functionally Relevant Coronary Artery Lesions

Objective To analyze the diagnostic value of single photon emission computed tomography(SPECT) myocardial perfusion imaging(MPI) and coronary CT angiography(CCTA) for functionally relevant coronary artery disease(FRCAL). Methods A total of 85 patients with suspected coronary heart disease(CAD) in vasculocardiology department of our hospital were treated with CCTA and SPECT-MPI with the same machine. The degree of coronary stenosis was diagnosed according to the results of CCTA, the 17-segments 5-sections method was used to analyze MPI imagining, the abnormal area of myocardial perfusion and blood-supply coronary artery lesion were matched on the CCTA/MPI fusion images, the correlation between myocardial perfusion abnormalities and blood-supply coronary artery stenosis was evaluated. Coronary angiography(CAG) was performed within 15 days, the diagnosis value of FRCAL with CCTA/MPI fusion imaging was analyzed. Results The patients amounts of myocardial perfusion with normal, mild abnormalities, moderate abnormalities and severe abnormalities were 7, 27, 37 and 10, there were 4 cases without perfusion;87 perfusion abnormal areas were found, the average blood perfusion score was(2.56±0.80). Of the 87 myocardial perfusion abnormalities areas, 12 had normal coronary blood supply, the average stenosis rate in the residual anomaly area was(66.78±10.25)%. The more severe myocardial perfusion abnormality was, the higher the degree of blood-supply coronary artery stenosis(P<0.05). Correlation analysis showed that myocardial blood perfusion score was significantly positively correlated with the degree of coronary stenosis(P<0.05). There were 66 cases of FRCAL by the CAG diagnosis. Taking CAG as the standard, the sensitivity, specificity and accuracy of diagnosis of FRCAL by CCTA/MPI fusion imaging were as high as 92.42%, 84.21% and 90.59%, respectively. Conclusion Myocardial perfusion abnormality is closely related to coronary stenosis. CCTA/MPI fusion imaging can be used to diagnose FRCAL, which helps to provide a basis for accurate diagnosis of CAD.