腺苷负荷试验心肌核素显像对冠心病诊断价值的评估

目的分析腺苷负荷试验心肌核素显像对于冠心病诊断的敏感性、特异性及其特点。方法住院患者同时行冠状动脉（冠脉）造影和腺苷负荷试验心肌核素显像。腺苷总量为840μg／kg,6min匀速静脉泵入,腺苷泵入3min时静脉推注^99m锝-甲氧基异丁基异腈核素显像925MBq,1．5h后进行心肌断层显像,若异常,次日行静息心肌显像。结果冠脉造影阳性50例中,心肌核素显像阳性44例。29例冠脉造影无明显狭窄,其中19例心肌核素显像阴性。腺苷负荷试验心肌核素显像对于冠心病诊断的敏感性和特异性为88．O％和65．5％。前降支病变40例,心肌核素前壁区域低灌注32例,回旋支病变27例,侧壁区域低灌注21例,右冠脉病变32例,下壁区域低灌注31例,右冠脉病变较前降支或回旋支病变的心肌核素显像阳性率高（P〈0．05）。结论腺苷负荷试验心肌核素显像对于冠心病诊断的敏感性、特异性较高。

The application of adenosine stress myocardial perfusion tomographic imaging in detecting coronary artery disease

OBJECTIVE: To analyze the sensitivity and specificity of adenosine stress myocardial perfusion tomographic imaging for the diagnosis of coronary artery disease (CAD). METHODS: Adenosine was infused intravenously at a rate of 140 microg.kg(-1).min(-1) for 6 minutes. 3 minutes after adenosine infusion, 925 MBq of (99m)Tc-MIBI were injected intravenously. SPECT myocardial imaging acquisition was obtained 1.5 hours after adenosine infusion. If the result was abnormal, rest myocardial perfusion imaging would be performed next day. Coronary angiography was performed in all patients within one week of myocardial imaging. RESULTS: Total 79 cases (62 +/- 10) years old, 35 men, 44 women] were included in this study. In the 50 cases of CAD patients confirmed by coronary angiography, 44 patients have positive adenosine (99m)Tc-MIBI myocardial perfusion SPECT. Nineteen out of 29 cases without CAD have negative adenosine myocardial perfusion tomographic imaging. The sensitivity and specificity of adenosine myocardial perfusion tomographic imaging for the diagnosis of CAD were 88.0% and 65.5%. The sensitivity of adenosine myocardial perfusion tomographic imaging for diagnosing coronary stenosis in left anterior descending, left circumflex and right coronary artery are 32/40, 21/27 and 31/32. There was no severe adverse side effect during adenosine stress test. CONCLUSION: Adenosine stress myocardial perfusion tomographic imaging is an useful non-interventional method for detecting coronary artery disease.