99Tcm-MIBI心肌灌注显像诊断效能与安全性评价的回顾
性研究
王荣福;王茜;张建华;张旭初;米宏志;郭芳;焦建;于治国;陈雯;孙晓昕;李河北;邱艳丽;岳明纲;任凌;王立勤;张春丽;王蒨;姚稚明;田月琴;何作祥;戴皓洁
【期刊名称】《中华核医学与分子影像杂志》 【年(卷),期】2012(032)006
【摘要】Objective To evaluate the diagnostic accuracy and safety of 99Tcm-MIBI MPI by retrospectively analyzing data from this multicenter study.Methods Participating centers included six hospitals:Peking University First Hospital,Beijing Fuwai Hospital of Chinese Academy of Medical Science and Peking Union Medical College,Anzhen Hospital of Capital Medical University,Beijing Hospital of Health Ministry,Beijing Tongren Hospital of Capital Medical University and Peking University People's Hospital.According to the inclusion and exclusion criteria,500 subjects (335 male,165 female,mean age (60.1 ±11.1) years) who underwent MPI between April 1998 and April 2006 were enrolled.All subjects were investigated with stress/rest MPI and CAG within 1 month.Stress test was performed with bicycle ergometry or with intravenous dipyridamole,adenosine or ATP.Perfusion defects on MPI were allocated to corresponding coronary arteries.During the stress and imaging period,any discomfort or symptoms were recorded.Coronary stenosis with ≥ 50％ luminal narrowing was considered significant in
CAG and taken as the gold standard.99Tcm-MIBI MPI results for the number of stenosed vessels,stenotic severity and coronary artery allocation were compared usingx2 test.Results There were 280 subjects that underwent exercise stress tests and the remaining 220 received pharmacological stress tests (117 adenosine,32 dipyridamole,71 ATP).Two hundred and forty-nine patients had significant coronary stenosis and 251 had normal CAG.Out of the 249 patients with positive CAG results,101 had one-vessel,66 had two-vessel and 82 had three-vessel disease.Significant stenosis of the LAD was present in 205 patients,144 had RCA stenosis and 130 had stenosis of the LCX.The sensitivity,specificity,accuracy,positive predictive and negative predictive values of MPI for detection of coronary artery disease were 65.1％ (162/249),81.3％ (204/251),73.2％ (366/500),77.5％ (162/209) and 70.1％ (204/291),respectively.There was no significant difference in the detection sensitivity of MPI between one-vessel disease and two-vessel disease (52.5％ (53/101) vs 65.2％ (43/66),x2 =2.624,P ＞ 0.05),while the sensitivity was significantly higher for three-vessel disease than that for one-vessel plus two-vessel disease (80.5％ (66/82) vs 57.5％ (96/167),x2 =12.801,P ＜ 0.01).The sensitivities among coronary artery stenosis subgroups of 50％-59％,60％-69％,70％-79％,80％-89％,90％-99％ were 38.8％ (40/103),39.6％ (19/48),43.4％ (53/122),51.2％ (41/80)and 52.7％ (48/91),respectively and not significantly different (x2 =5.721,P ＞
0.05),while it was significantly higher in the subgroup with 100％ stenosis (82.9％ (29/35),x2 =18.362,P ＜ 0.01).The sensitivity for LCX lesions was lower than that for LAD and RCA (x2 =7.619,P ＜ 0.01),whereas the specificity and accuracy had no significant difference (x2 =0.758,4.471,both P ＞ 0.05).Mild side-effects during the study were recorded in 21 patients and were relieved without medical treatment.Conclusion 99Tcm-MIBI MPI is accurate and safe for the detection of coronary artery disease.%目的 通过回顾性分析,评价99Tcm-MIBI心肌灌注显像的有效性及安全性.方法 选择来自6家医院共500例在1998年4月7日至2006年4月6日之间同时或者分别行99Tcm-MIBI MPI(包括静息显像和负荷显像)和CAG的患者.研究对象年龄33～88(60.1±11.1)岁,其中男335例,女165例.以CAG结果为“金标准”(1支血管狭窄≥50％为阳性),计算99Tcm-MIBI MPI的诊断效能.不同受累冠状动脉支数、狭窄程度及病变部位的99Tcm-MIBI MPI结果采用x2检验进行对比.统计所有患者在显像中的不良反应发生情况.结果 500例中运动负荷显像280例,药物负荷220例(腺苷负荷117例,ATP负荷71例,双嘧达莫负荷32例)；CAG阳性249例,阴性251例；累及LAD 205例,RCA 144例,LCX 130例；单支病变101例,双支病变66例,三支病变82例.99Tcm-MIBI MPI诊断心肌缺血及心肌梗死的灵敏度为65.1％(162/249),特异性为81.3％ (204/251),准确性为73.2％ (366/500),阳性预测值为77.5％(162/209),阴性预测值为70.1％(204/291).99Tcm-MIBI MPI对单支病变与双支病变的诊断灵敏度差异无统计学意义[52.5％ (53/101)与65.2％ (43/66),x2=2.624,P＞0.05],而对三支病变
99Tcm-MIBI心肌灌注显像诊断效能与安全性评价的回顾性研究
