门控~（99m）Tc－MIBI心肌断层显像诊断多支冠状动脉病变和心肌缺血

目的：评价门控心肌显像诊断冠心病（ＣＡＤ）的临床意义。方法：对３２例ＣＡＤ患者的９９ｍＴｃ—甲氧基异丁基异腈（ＭＩＢＩ）门控。非门控心肌断层显像和冠状动脉造影进行了比较，以及对４０例ＣＡＤ患者的门控与常规潘生丁─静息心肌断层显像也作了比较。结果：１．门控与非门控显像法诊断ＣＡＤ的灵敏度和特异性无差别，但前者对检测病变冠状动脉和诊断多支冠状动脉病变性ＣＡＤ的灵敏度高于后者，而特异性无差别。２．射血分数（ＥＦ）值显著影响非门控图像的病变显示。３．与非门控显像比较，门控显像能观察到更多的再分布节段和较少的无再分布节段。静息门控心肌显像除发现较多的灌注异常外，还观察到了许多单纯收缩功能受损节段。后者虽然可判断８４％的灌注再分布节段，但特异性不高。结论：门控心肌断层显像对诊断ＣＡＤ无优势，但对诊断ＥＦ值较高的或多支冠状动脉病变性ＣＡＤ、检测病变冠状动脉和心肌缺血有一定价值。

GATED SPECT IMAGING WITH ~(99m)Tc-MIBI IN THE DETECTION OF ISCHEMIC HEART DISEASE AND MULTIVESSEL CORONARY ARTERY DISEASE

PURPOSE To evaluate gated SPECT myocardial imaging in the detection of coronary artery disease(CAD). METHODS Gated and ungated myocardial SPECT imaging with 99mTc-MIBI in 32 cases of CAD was compared with cardioangiography.Gated and routine Persantin rest myocardial SPECT imaging has been compared also in 40 cases.RESULTS 1.Both gated and ungated imaging had similar sensitivity and specificity for CAD.But gated imaging has higher sensitivities in the detection of multivessels than ungated imaging without loss of specificities.2.In ungated studies,the lower sensitivity with higher EF values has been observed.3.More reversible segments and less irreversible segments can be found in gated studies.Many of abnormal segments were identified by rest gated imaging as contraction dysfunction with normal per fusion.Though 84% reversible segments can be predicted by dysfunctional segments at rest studies,the specificity is significantly low.CONCLUSION Gated SPECT myocardial perfusion imaging has higher sensitivity in the detection of stenosed coronary arteries especially in the patients with higher EF values and multivessels CAD.Gated perfusion imaging can be used for the assessment of ischemic heart disease,because more reversible segments can be found.