CTCA联合CT首过心肌灌注成像检查在无症状性心肌缺血诊断中的应用效果

摘要

目的 分析CT冠状动脉(CTCA)联合CT首过心肌灌注成像(CT first-pass MPI)检查在无症状性心肌缺血(SMI)诊断中的应用价值.方法 选取2016年4月至2017年12月胶州市人民医院收治的79例疑似SMI患者,均行核素心肌灌注成像(MPI)、CTCA检查、CT first-pass MPI检查,以MPI检查结果为准,统计CTCA检查、CT first-pass MPI检查、联合检查确诊SMI情况及诊断灵敏度、准确度、特异度.结果 79例SMI患者中:MPI检出48例SMI,31例无心肌缺血;CTCA检出50例SMI,29例无心肌缺血;CT first-pass MPI检出53例SMI,26例无心肌缺血;联合检查检出54例SMI,25例无心肌缺血;CTCA检查、CT first-pass MPI检查、联合检查灵敏度、准确度比较差异显著(P＜0.05);联合检查灵敏度95.83％、准确度87.34％高于CTCA检查72.92％、64.56％(P＜0.05).结论 CTCA与CTfirst-pass MPI联合应用诊断SMI,不仅可了解冠脉狭窄程度与位置,亦可观察心肌血流灌注情况,诊断价值较高.%Objective To observe the application value of CT coronary angiography (CTCA) combined with CT first-pass myocardial perfusion imaging (MRI) in the diagnosis of silent myocardial ischemia (SMI).Methods Seventy-nine patients with suspected SMI admitted to Jiaozhou People's Hospital from April of 2016 to December of 2017 were examined by MPI,CTCA and CT first-pass MRI.Based on the results of MPI,were used to determine the diagnostic sensitivity,accuracy and specificity of CTCA,CT first-pass MPI and combined examination were counted.Results Among 79 SMI patients,48 SMI cases were diagnosed by MPI,31 without myocardial ischemia;50 SMI cases were diagnosed by CTCA,29 without myocardial ischemia;53 SMI cases were detected by CT first-pass MPI,26 without myocardial ischemia;54 SMI cases were detected by joint examination,25 without myocardial ischemia.CTCA,CT first-MPI pass and combined examination had poor sensitivity and accuracy.The sensitivity and accuracy of combined examination were 95.83％ and 87.34％,higher than those of CTCA examination (72.92％ and 64.56％),and the differences were statistically significant (P ＜ 0.05).Conclusion The combined application of CTCA and CT first-pass MPI can not only show the degree and location of coronary stenosis in the diagnosis of SMI,but also display the myocardial perfusion.The diagnostic value is high.