双源 CT 冠脉成像和核素心肌灌注显像在冠心病临床诊断中的对比研究

摘要

Objective:To analyse the value of dual-source CT coronary artery imaging ( DSCTCA) and myocardial perfusion imaging ( MPI) for the clinical diagnosis of coronary artery disease ( CAD) .Method:115 patients with clinically confirmed or suspected coronary heart disease were separately DSCT and MPI in-spection within one week, and coronary angiography ( CAG) should be completed in a month.CAG was used as the gold standard for comparision of DSCTCA, MPI and combination for the diagnosis of CAD and the effi-ciency of the detected lesions of vessels.Result:In 115 patients,there were 68 patients diagnosed CAD, sin-gle-vessel lesions in 17 cases, 35 cases double-vessel lesion, three-vessel lesions in 16 cases;135 coro-nary artery luminal stenosis rate was more than 50%in 204 vessels.The sensitivity, specificity and accuracy of DSCTCA, MPI and the joint use for diagnosis of CAD were 82.4%(56/68), 80.9%(38/47), 81.7%(94/115);76.5%(52/68), 78.7%(37/47), 77.4%(89/115) and 92.6%(63/68), 76.6%(36/47), 54.8%(63/115);The sensitivity, specificity and accuracy of DSCTCA, MPI and the joint use for diagnosis of lesion vessels were 77.8%(105/135), 90.5%(190/210), 85.5%(295/345);73.3%(99/135), 73. 3%(99/135), 82.9%(286/345) and 85.2%(115/135), 82.9%(174/210), 33.3%(115/345).Con-clusion:DSCTCA and MPI are both important noninvasive examination method for clinical diagnosis of CAD. A combination of DSCTCA and MPI is better.%目的:对比研究双源 CT 冠脉成像( DSCTCA)和核素心肌灌注显像( MPI)对冠心病( CAD)的临床诊断价值. 方法:115例临床确诊或可疑冠心病患者一周内分别行DSCTCA和MPI检查,并在一个月内完成冠脉造影( CAG). 以CAG结果为金标准,比较DSCTCA、MPI及两者联合运用诊断CAD、检出病变血管的效能. 结果:115例患者中,CAG有一支及一支以上冠脉管腔狭窄≥50%的患者68例,其中单支病变17例,双支病变35例,三支病变16例;共计204支,管腔狭窄率≥50%的冠脉累计135支. DSCTCA、MPI及二者联合运用诊断CAD的灵敏度、特异性及准确性分别为82.4%(56/68)、80.9%(38/47)、81.7%(94/115);76.5%(52/68)、78.7%(37/47)、77.4%(89/115)和92.6%(63/68)、76.6%(36/47)、54.8%(63/115);DSCTCA、MPI和两者联合使用检出病变血管的灵敏度、特异性及准确性分别是77.8%(105/135)、90.5%(190/210)、85.5%(295/345);73.3%(99/135)89.0%(187/210)、82.9%(286/345)和85.2%(115/135)、82.9%(174/210)、33.3%(115/345). 结论:DSCT-CA和MPI均是临床诊断CAD的重要无创影像学检查方法,两者结合既能灵敏诊断心肌缺血,又能较好反映冠脉血管病变,为冠心病治疗方案的选择提供有效依据.