核素心肌灌注显像与64层螺旋CT诊断冠状动脉疾病的对比研究

目的 对比分析心肌灌注显像（MPI）与64层螺旋CT（MSCT）对冠状动脉疾病（CAD）的诊断价值.方法 对52例可疑和确诊CAD患者（疑诊43例,确诊9例）进行MPI检查,并均在1个月内行冠状动脉造影（CAG）和64层MSCT检查.MPI结果分析采用17节段5分制,获得运动负荷显像灌注总积分和静息显像灌注总积分,两者差值大于1为心肌缺血,判断为阳性.MSCT结果主要以冠状动脉或其主要分支中至少有1支血管管腔狭窄≥50%判定为阳性.以CAG结果为诊断CAD的＂金标准＂.采用SPSS 13.0软件,用Kappa值检验2种方法结果的一致性,两样本率的比较采用配对资料x2检验.结果 MPI和MSCT诊断CAD的灵敏度、特异性、阳性预测值、阴性预测值及准确性分别为86.7%（26/30）、77.3%（17/22）、83.9%（26/31）、81.0%（17/21）、82.7%（43/52）和83.3%（25/30）、86.4%（19/22）、89.3%（25/28）、79.2%（19/24）、84.6%（44/52）;MPI和MSCT对病变血管检出的灵敏度、特异性、阳性预测值、阴性预测值及准确性分别是74.5%（38/51）、81.0%（85/105）、65.5%（38/58）、86.7%（85/98）、78.8%（123/156）和90.2%（46/51）、88.6%（93/105）、79.3%（46/58）、94.9%（93/98）、89.1%（139/156）,2种方法诊断CAD和病变血管差异均无统计学意义（x2=0.44和0.21,P均＞0.05）.MSCT评价病变血管轻度、中度和高度狭窄的灵敏度分别为76.5%（13/17）,78.3%（18/23）和89.6%（43/48）.MPI和MSCT诊断CAD的效能相近,Kappa值为0.64（＜0.75）.25例2种方法均阳性患者,96.0%（24/25）确诊为CAD;18例均阴性的患者,83.3%（15/18）可排除CAD.结论 MPI和MSCT均为筛选、诊断CAD的重要无创检查手段,但信息互补,不可替换.

Comparative study of myocardial perfusion imaging and 64 multi-slice spiral CT for the diagnosis of coronary artery disease

Objective To compare the diagnostic value of myocardial perfusion imaging (MPI) and 64 multi-slice spiral CT (64-MSCT) for coronary artery disease (CAD). Methods Fifty-two patients with suspected or known CAD were included in the study. Each patient underwent both stress and rest MPI,MSCT as well as conventional coronary angiography (CAG) within 1 month. The stress and rest MPI were scored by a 5-grade criteria (0 ～ 4) based on 17 coronary artery segments. The difference between summed stress and rest scores ＞ 1 was defined as myocardial ischemia. Stenosis in one main vessel or one main branch of the main vessel ≥50% was defined as myocardial ischemia by MSCT. CAG was used as the reference for comparison. Statistical analysis was performed using SPSS 13. 0 software. Kappa value was used to test the accordance of MPI and MSCT results. X2 test was used to evaluate the difference between MPI and MSCT results. Results The patient-based sensitivity, specificity, positive and negative predictive values and accuracy of MPI and MSCT for the diagnosis of CAD were 86.7% (26/30), 77.3% ( 17/22),83.9% (26/31), 81.0% ( 17/21), 82.7% (43/52) and 83.3% ( 25/30), 86.4% ( 19/22), 89.3%( 25/28), 79.2% ( 19/24), 84.6% (44/52), respectively. The vessel-based sensitivity, specificity, positive and negative predictive values and accuracy of MPI and MSCT were 74.5% (38/51), 81.0% (85/105 ), 65.5% (38/58), 86.7% ( 85/98), 78.8% ( 123/156 ) and 90.2% (46/51 ), 88.6% ( 93/105 ),79.3 % (46/58), 94.9% (93/98), 89.1% ( 139/156), respectively. There was no statistically significant difference between MPI and MSCT for either patient or lesion-based diagnosis (X2 =0.44, 0.21, both P ＞0.05 ). 96.0% (24/25) patients with both abnormal MPI and MSCT positive were valified by CAG while 83.3% (15/18) patients with both MPI and MSCT negative were excluded by CAG. Conclusions Both MPI and MSCT are reliable diagnostic modalities for CAD. They also provide complementary diagnostic value to each other.