腺苷负荷心肌灌注显像评价中年女性心肌供血异常的临床价值

目的:评价国产腺苷负荷99Tcm-MIBI心肌灌注显像对65岁以下的中年女性患者心肌供血异常的判断临床价值。方法:2007年1月至2008年7月临床怀疑冠心病的中年女性109例,年龄40～65岁,平均年龄(54.9±6.1)岁,所有患者均在1个月内施行常规2d法腺苷负荷-静息心肌灌注显像(MPI)和冠状动脉造影术(CAG)检查。MPI和CAG图像由2名以上核医学/放射科医师共同读片;MPI评价标准:供血区某一心肌节段负荷时,出现放射性稀疏或缺损,静息时消失或改善,判定为心肌缺血;如静息时仍为放射性缺损,判定为心肌梗死。CAG评价标准:3支主要冠状动脉血管中至少有1支主要冠状动脉管径狭窄≥50%,判定为阳性。MPI与CAG对照,评价腺苷MPI对冠心病的诊断效能(敏感性、特异性和准确性)。结果:109例受检者中,MPI显示:阴性62例,阳性47例,心肌缺血42例,心肌梗死5例;累及59个室壁段,其中前降支供血区32段,回旋支供血区12段,右冠状动脉供血区15段。CAG显示:冠状动脉正常72例,冠状动脉异常37例,其中单支病变23例,双支病变7例,3支病变7例;冠状动脉异常37例中核素心肌灌注显像阳性31例,阴性6例;冠状动脉正常72例中核素心肌灌注显像56例阴性,16例阳性。腺苷负荷MPI对65岁以下女性患者诊断冠心病的灵敏度为83.8%(31/37例),特异性为77.8%(56/72例),准确性为79.8%(87/109例),阳性预测值为65.9%(31/47例),阴性预测值为90.3%(56/62例)。结论:腺苷负荷心肌灌注显像用于中年女性冠心病的诊断有较高的诊断效能,具有较高的临床应用价值。可作为中年女性早期诊断冠心病在运动心电图之外有效的、优先考虑的选择。

The diagnostic value of adenosine stress test myocardial perfusion imaging for middle-aged female patients

Objective:Evaluating the clinical value of adenosine stress test myocardial perfusion imaging(MPI) by 99Tcm-MIBI for middle-aged female.Methods:Analyzing 109 suspected CAD middle-aged female patients from Jan.2007 to Jul.2008,age from 40 to 65(average age is(54.9± 6.1) years old),and all patients underwent two days adenosine stress/rest MPI and coronary angiography(CAG) in one month.The images of MPI and CAG were evaluated by more than 2 nuclear medicine physicians and radiologists.The MPIevaluation criterion is: myocardial ischemia is diagnosed if there is decrease or defect of radioactivity at stress test in some myocardial segment with improvement of radioactivity at rest;and myocardial infarction is diagnosed if it is still defect of radioactivity combined with stress.CAG evaluation criterion is: it is judged positive if stenosis equal or larger than 50% in one of three main coronary arteries at least.Statistics analyses were performed by mean ± standard deviation.Diagnostic efficacy is evaluated for CAD by MPI compared with CAG(sensitivity,specificity and accuracy).Results:In all 109 patients,MPI showed: 62 negtive,47 positive,42 myocardial ischemia and 5 myocardial infarction;involving 59 segments including LAD 32,LCX 12 and RCA 15.CAG showed: 72 normal coronary arteries with 56 negative MPI and 16 positive MPI;37 abnormal ones including 23 one-vessel stenosis,7 two-vessel stenosis and 7 three-vessel stenosis,with 31 positive MPI,6 negative MPI;the sensitivity,specificity,accuracy,positive predictive value and negative predictive value of adenosine stress MPI for female patients to diagnosing CAD is 83.78%(31/37),77.78%(56/72),79.82%(87/109),65.90%(31/47),90.32%(56/62)individually.Conclusion:There is higher clinical value and diagnostic efficacy of adenosine stress test MPI for diagnosing CAD with middle-aged female patients.And it can be a good choice for diagnosing early CAG with middle-aged female besides exercise ECG.