SPECT心肌灌注显像和冠脉CTA及其融合图像对冠心病的诊断价值比较

目的比较单光子发射型计算机断层(SPECT)心肌灌注显像(MPI)和冠脉CT血管造影(CCTA)及其融合图像对冠心病的诊断价值。方法选取2017年6月至2018年10月我院疑诊冠心病患者70例,均行SPECT/CT心肌灌注显像和CCTA检查,并于15日内行冠脉造影(CAG)诊治,分析其影像特点及对冠心病的诊断价值。结果70例患者中MPI提示正常、异常分别5例、65例,其中心肌缺血60例,心肌梗死5例,共210个节段,节段灌注异常68段,灌注正常142段,灌注异常节段心肌血流量(MBF)、心肌血容量(MBV)低于灌注正常节段,而达峰时间(TTP)较灌注正常节段延长(P<0.01);CCTA发现冠脉异常、正常分别53例、17例,其中93个节段异常,冠脉狭窄≥50%,117个节段正常;MPI/CCTA融合影像提示,冠脉异常(存在功能相关冠脉狭窄)56例、正常14例,以CAG为诊断金标准,MPI/CCTA融合显像诊断冠心病的灵敏度、特异度、准确度均明显高于MPI及CCTA(P<0.05)。结论MPI与CCTA对冠心病均有较好诊断效能,尤其是MPI/CCTA融合显像可明确冠脉狭窄与其功能状态的关系,提高功能相关冠脉病变检出率,有望成为冠心病诊断的首选方法。

Comparison of SPECT Myocardial Perfusion Imaging,Coronary CTA and Their Fusion Images in the Diagnosis of Coronary Heart Disease

Objective To compare the diagnostic value of single photon emission computed tomography(SPECT) myocardial perfusion imaging(MPI), coronary CT angiography(CCTA) and their fusion images in coronary heart disease. Methods 70 patients with suspected coronary heart disease in our hospital from June 2017 to October 2018 were chosen. All patients were given SPECT/CT myocardial perfusion imaging and CCTA examination. Coronary angiography(CAG) was performed with in 15 days, the image characteristics and diagnostic value of coronary heart disease were analyzed. Results Among the 70 patients, MPI showed 5 normal and 65 abnormal patients, including 60 cases of myocardial ischemia, 5 cases of myocardial infarction, 210 sections, 68 sections of abnormal perfusion, 142 sections of normal perfusion, myocardial blood flow(MBF) and myocardial blood volume(MBV) in the abnormal perfusion segment were lower than those in the normal perfusion segment, the peak time(TTP) was longer than that in the normal perfusion segment(P<0.01). CCTA found there were coronary artery abnormalities and normal of 53 cases and 17 cases respectively, of which 93 segments were abnormal, coronary stenosis was greater than or equaled to 50%, 117 segments were normal;MPI/CCTA fusion images suggested that there were coronary artery abnormalities(functionrelated coronary stenosis) and normal of 56 cases and 14 cases respectively, taking CAG diagnosis as the gold standard, the sensitivity, specificity and accuracy of coronary heart disease by MPI/CCTA fusion diagnosis were significantly higher than those by MPI and CCTA(P<0.05). Conclusion Both MPI and CCTA have good diagnostic efficacy for coronary heart disease, especially the fusion imaging of MPI/CCTA can confirm the relationship between coronary stenosis and functional status, improve the detection rate of functionally relevant coronary artery lesions, it may become the first choice for the diagnosis of coronary heart disease.