心肌灌注显像结合冠状动脉 CT 血管造影在冠心病诊治中的应用价值

摘要

Objective To investigate myocardial perfusion imaging (MPI) combined with coronary CT angiography (CTA) in diagnosis of "culprit"coronary artery.Methods From 2012 February-2013 December, hospitalized patients with coronary heart disease (33 cases) were enrolled, male of 25 cases, female of 8 cases, age from 35 to 75 years old (55.2 ± 20.2), they were underwent13 N-NH3 PET adenosine /resting MPI and coronary artery CTA examination , within 1 months of coronary arteriography (CAG), respectively.The MPI, CTA and CAG were analyzed;using CAG as golden standard, the di-agnostic value of coronary CTA , MPI and MPI combined coronary artery CTA were analyzed .Results (1) The sensitivity of CTA in diagnosis of coronary heart disease was 90.0%(36/40), the specificity was 95.0%(302/318), the positive predic-tive value was 69.2%(36/52), the negative predictive value was 98.7%(302/306).(2) The sensitivity of MPI in diagno-sis of coronary heart disease was 90.9% (20/22), the specificity was 90.9% (10/11), the positive predictive value was 95.2%(20/21), the negative predictive value was 83.3%(10/12).(3) The sensitivity of MPI combined with CTA in diag-nosis of coronary heart disease was 95.5%(20/21), the specificity was 100% (11/11), the positive predictive value was 100%(21/21), the negative predictive value was 91.7%(11/12).Conclusion MPI combined with coronary CTA can de-crease the"false positive"and"false negative"results caused by MPI or CTA alone , provides higher accuracy for the diagno-sis and treatment of coronary heart disease , especially to improve the detection rate of "culprit"vessel.%目的：探讨心肌灌注显像（MPI）结合冠状动脉CT血管造影（CTA）对冠心病诊断及准确定位“罪犯”血管的价值。方法收集2012年2月-2013年12月住院的冠心病患者33例，男25例，女8例，年龄35～75（55�．2±20．2）岁，均行13N-NH3PET 腺苷负荷/静息MPI及冠状动脉CTA检查，1个月内完成冠状动脉造影（CAG），分别对MPI、CTA及CAG结果进行分析，以CAG结果为金标准，分析冠状动脉CTA、MPI及MPI联合冠状动脉CTA的诊断价值。结果（1）冠状动脉CTA诊断冠心病的灵敏度为90．0％（36/40）、特异度为95．0％（302/318）、阳性预测值为69．2％（36/52）、阴性预测值为98．7％（302/306）。（2） MPI 诊断冠心病的灵敏度为90．9％（20/22）、特异度为90．9％（10/11）、阳性预测值为95．2％（20/21）、阴性预测值为83．3％（10/12）。（3）MPI联合冠状动脉CTA诊断冠心病的灵敏度为95．5％（20/21）、特异度为100％（11/11）、阳性预测值为100％（21/21）、阴性预测值为91．7％（11/12）。结论 MPI结合冠状动脉CTA可减少单纯MPI或CTA造成的“假阳性”和“假阴性”，为冠心病的诊治提供更高准确性，尤其是提高了对“罪犯血管”的检出率。