负荷动态CT心肌灌注成像对心肌缺血的诊断价值

发布时间：2018-03-06 04:19

本文选题：负荷心肌灌注成像　切入点：双源CT　出处：《临床放射学杂志》2015年01期 　论文类型：期刊论文

【摘要】：目的探讨128双源CT(DSCT)行负荷动态心肌灌注检查对心肌缺血的诊断价值。方法 30例临床疑似或已知冠心病患者行负荷动态CT心肌灌注(CT-MPI)检查,获取其心肌血流值。以SPECT为参考标准,评价CTMPI诊断心肌灌注缺损的敏感性、特异性、阳性预测值(PPV)、阴性预测值(NPV)、准确性及其与SPECT诊断的一致性。结果 30例患者成功完成检查,所有节段平均心肌血流量(MBF)值为(99.11±31.98)ml·100ml-1·min-1,非缺血区MBF值(117.61±29.82)ml·100ml-1·min-1与缺血区MBF值(80.60±22.15)ml·100ml-1·min-1有显著的统计学差异(t=15.764,P0.001)。CT-MPI检查中19例26个血管支配区域出现CT-MPI的灌注缺损,以节段为基础,出现灌注缺损者为52段。SPECT-MPI检出心肌灌注异常13例16个血管区,共34个心肌节段。以SPECT为参照,以人为基础,CT-MPI检测心肌缺血的敏感性、特异性、PPV和NPV分别为92.31%(12/13)、58.82%(10/17)、63.16%(12/19)和90.91%(10/11),准确性为73.33%,两种检查方式结果的一致性Kappa=0.485(P0.005);以血管区和节段为基础,CT-MPI检测心肌缺血的敏感性、特异性、PPV和NPV分别为93.75%(15/16)、85.14%(63/74)、57.69%(15/26)、98.44%(63/64)和94.12%(32/34)、95.80%(456/476)、61.54%(32/52)、99.56%(456/458),准确性分别为86.67%和95.69%。两种检查结果的一致性分别为Kappa=0.634和0.772(P均0.001)。结论负荷动态CT-MPI可较好地检测出心肌灌注缺损,对心肌缺血情况进行评估。
[Abstract]:Objective to investigate the value of dual source CT (128 DSCT) for dynamic load myocardial perfusion examination in diagnosis of myocardial ischemia. Methods 30 cases with suspected or known coronary artery disease underwent dynamic load CT myocardial perfusion (CT-MPI) examination, obtain the myocardial blood flow. Taking SPECT as the reference standard, the sensitivity evaluation of CTMPI diagnosis of myocardial perfusion defect specificity (PPV), positive predictive value, negative predictive value (NPV), and SPECT diagnosis accuracy and consistency. Results 30 patients successfully completed the examination, all segments of the average myocardial blood flow (MBF) = (99.11 + 31.98) ML - 100ml-1 - min-1, non ischemic MBF value (117.61 + 29.82 ML - 100ml-1 - min-1) and ischemic MBF value (80.60 + 22.15) ML - 100ml-1 - min-1, there is a statistically significant difference (t=15.764, P0.001).CT-MPI examination in 19 cases of 26 vascular control area CT-MPI perfusion defects to segment based perfusion defect appeared Detection of myocardial perfusion abnormalities in 13 cases of 16 vascular areas was 52.SPECT-MPI, a total of 34 segments. Based on SPECT, based on human, sensitivity, specificity of CT-MPI in detecting myocardial ischemia, PPV and NPV were 92.31% (12/13), 58.82% (10/17), 63.16% (12/19) and 90.91% (10/11), the accuracy was 73.33%, the consistency of Kappa=0.485 two examination results (P0.005); vascular area and segment based CT-MPI myocardial ischemia detection sensitivity, specificity, PPV and NPV were 93.75% (15/16), 85.14% (63/74), 57.69% (15/26), 98.44% (63/64) and 94.12% (32/34), 95.80% (456/476), 61.54% (32/52), 99.56% (456/458), consistency and accuracy were 86.67% and 95.69%. two test results were Kappa=0.634 and 0.772 (P 0.001). Conclusion the load dynamic CT-MPI can better detect myocardial perfusion defect, to evaluate myocardial ischemia.

【作者单位】：南京医科大学附属无锡市人民医院医学影像科;
【分类号】：R541.4;R816.2

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