摘要
目的研究SPECT/CT核素心肌灌注显像(MPI)和冠状动脉CT血管成像(CCTA)诊断冠脉慢性完全闭塞(CTO)的临床价值。方法选取2017年6月至2018年3月我院174例冠心病患者分别进行冠状动脉造影(CAG)、CCTA和SPECT/CT MPI检查,比较CCTA、CT衰减校正MPI(CTAC)和无衰减校正(NOAC)诊断CTO准确性并进一步分析三种检查方法在CTO治疗和预后中的应用价值。结果174例冠心病患者进行CAG检查确诊为CTO者53例,占比30.46%,其中LAD病变18例(33.96%)、LCX病变7例(13.21%)、RCA病变28例(52.83%)。CCTA、CTAC和NOCA诊灵敏度分别为92.45%、77.36%、79.24%,特异度分别为95.04%、96.69%、93.39%,准确度分别为94.25%、90.80%、89.08%,一致性检验Kappa值分别为0.866、0.773、0.738;CCTA对病变血管长度和侧支循环评估结果与CAG无明显差异(P>0.05);CTAC显示SRS、SDS及负荷TPD高于NOAC,SSS和静息TPD低于NOAC,差异有统计学意义(P<0.05)。结论CCTA可清晰显示病变冠脉解剖学特征,用于CTO诊断准确性与CAG相当,MPI则可对CTO患者灌注水平进行定量分析,经CT衰减校正可进一步提高检查结果准确性,对指导治疗和评估预后具有重要价值。
Objective To study the clinical value of SPECT/CT radionuclide myocardial perfusion imaging(MPI)and coronary CT angiography(CCTA)in the diagnosis of chronic total occlusions(CTO).Methods 174 patients with coronary heart disease in our hospital from June 2017 to March 2018 were given coronary angiography(CAG),CCTA and SPECT/CT MPI,and the accuracies of CCTA,CT attenuation correction MPI(CTAC)and no attenuation correction(NOAC)in diagnosing CTO were compared,and the application value of three examination methods in CTO treatment and prognosis was further analyzed.Results Of the 174 patients with coronary heart disease who underwent CAG,53 patients were diagnosed as CTO,accounting for 30.46%,including 18 cases of LAD lesions(33.96%),7 cases of LCX lesions(13.21%)and 28 cases of RCA lesions(52.83%).The sensitivities of CCTA,CTAC and NOCA were 92.45%,77.36% and 79.24% respectively,and the specificities were 95.04%,96.69% and 93.39% respectively,and the accuracies were 94.25%,90.80% and 89.08% respectively,and the Kappa values of consistency test were 0.866,0.773 and 0.738 respectively.There were no significant differences between CCTA and CAG in the evaluation of diseased vessel length and collateral circulation(P>0.05).CTAC showed that SRS,SDS and load TPD were higher than those of NOAC,and SSS and resting TPD were lower than those of NOAC(P<0.05).Conclusion CCTA can clearly show the anatomical features of diseased coronary arteries.And its accuracy of CTO diagnosis is comparable to that of CAG.MPI can quantitatively analyze the perfusion level of CTO patients.CT attenuation correction can further improve the accuracy of examination results,and it has important value in guiding treatment and assessing prognosis.
作者
薛艳丽
李立峰
亓冬梅
XUE Yan-li;LI Li-feng;QI Dong-mei(Department of Nuclear Medicine,Jinan People's Hospital,Jinan 271100,Shandong Province,China)
出处
《中国CT和MRI杂志》
2022年第2期72-74,共3页
Chinese Journal of CT and MRI
