摘要:
目的 评价99Tcm-双(N-乙氧基,N-乙基-二硫代氨基甲酸酯)氮化锝(99Tcm-NOET)静息门控断层心肌灌注显像对冠心病患者的诊断价值。方法 疑诊为冠心病的45例患者注射925 MBq 99Tcm-NOET后1h用SPECT行静息门控心肌灌注显像,获得舒张未期容积(EDV)、收缩未期容积(ESV)、左室射血分数(LVEF)等心功能参数和舒张末期容积灌注、局部射血分数、局部室壁活动和室壁增厚度4个靶心图。所有患者在1周内行冠状动脉造影,将冠状动脉狭窄≥50%定为病变血管。根据冠状动脉造影结果将其分为心肌梗死组、心肌缺血组和对照组三组。结果 99Tcm-NOET静息门控SPECT诊断冠心病的灵敏度和特异度分别为68.42%和83.33%。心肌梗死组的心功能参数[EDV=(129.32±9.14)ml,ESV=(80.97±9.49)ml,LVEF=(40.15±3.28)%]与对照组[EDV=(80.91±3.12)ml,ESV=(30.12±1.79)ml,LVEF=(63.51±1.04)%]相比,统计学差异有显著性(EDV:F=22.103,ESV:F=32.277,LVEF:F=42.604,均为P<0.01),心肌缺血组的心功能参数[(EDV=(70.83±3.46)ml,ESV=(25.13±2.85)ml,LVEF=(65.55±2.62)%]与对照组相比,统计学差异无显著性意义。心肌梗死组左室心肌共分为460个节段,其中209个节段局部灌注、局部射血分数、局部室壁活动和室壁增厚度4个靶心图均异常。局部灌注异常的节段共328个节段。伴有局部射血分数、局部室壁活动和室壁增厚度异常分别有250个、240个和276个节段。局部灌注异常的节段与局部射血分数、局部室壁活动和室壁增厚度异常的节段不完全匹配。结论 99Tcm-NOET静息门控心肌灌注显像对冠心病的诊断有较大临床应用价值,所获得的整体心室功能参数在心肌梗死的评价中有优越性,但对心肌缺血的诊断价值不大。心肌梗死中存在有不少的局部灌注与心肌室壁功能异常节段的不匹配,对心肌存活的评价有帮助。
Abstract:
Objective To predict the value of 99Tcm-bis(N-ethoxy-N-ethyl-dithiocarbamato)nitridotechnetium(99Tcm-NOET)gated myocardial perfusion SPECT on detecting coronary artery disease.Methods For evaluation of suspected coronary artery disease,45 men and 11 women(mean age,45.9±12.4)underwent the rest gated SPECT.SPECT imasing was began 1 hour after intravenous injection of 99Tcm-NOET at rest.The SPECT images acquired end diastolic volume(EDV),end systolic volume(ESV),left ventricular ejection fraction(LVEF).And were analyzed from end systolicregional perfusion.ejection fraction,motion and thickening by 4 polar maps.All of them underwent coronary angiography(≥50%luminal diameter stenosis was considered significant coronary stenosis).Results Sensitivity and specificity of 99Tcm-NOET rest gated myocardial perfusion SPECT for detecting coronary artery disease were 68.42% and 83.33%,respectively.There wag statistically significant difference for function parameters(EDV,ESV and LVEF)between myocardial infarction group[(129.32±9.14)ml,(80.97±9.49)ml,(40.15±3.28)%]and control group[(80.91±3.12)ml,(30.12±1.79)ml,(63.51±1.04)%,EDV:F=22.103,ESV:F=32.277,LVEF:F=42.604,P<0.01].There were not significant difference between control group and ischemic group[(70.83±3.46)ml,(25.13±2.85)ml,(65.55±2.62)%].In myocardial infarction group left ventricular were divided into 460 segments,and 209 segments were abnormal simultaneously in regional perfusion,ejection fraction,motion and thickening by 4 polar maps.Conclusion s 99Tcm-NOET rest SPECT is clinically feasible in detecting coronary artery disease.Global left ventricular function parameters have higher values in assessment of myocardial infarction and not have advantage in diagnose of coronary artery disease.In the patients with myocardial infarction,not matching between the regional perfusion and wall contraction function is useful to assessment of myocardial viability.
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