摘要
目的探讨CTCA结合CT首过心肌灌注成像对无症状性心肌缺血(SMI)的诊断价值。方法 72例临床疑诊SMI患者行核素心肌灌注成像(MPI)及CTCA检查。以MPI为参考标准,比较CT首过心肌灌注成像、CTCA结合CT首过心肌灌注成像诊断SMI的敏感性、特异性、阳性预测值、阴性预测值、准确性及其与MPI诊断的一致性。结果 72例患者完成检查,以患者为观察对象,CT首过心肌灌注成像诊断SMI的敏感性90.91%(40/44),特异性71.43%(20/28),阳性预测值83.33%(40/48),阴性预测值83.33%(20/24),准确性83.33%(60/72),两种检查结果的一致性Kappa=0.640(P<0.05);CTCA结合CT首过心肌灌注成像诊断SMI的敏感性95.45%(42/44),特异性75.00%(21/28),阳性预测值85.71%(42/49),阴性预测值91.30%(21/23),准确性87.50%(63/72),两种检查结果的一致性Kappa=0.728(P<0.05);以病变血管为观察对象,CT首过心肌灌注成像诊断SMI的敏感性88.89%(48/54),特异性89.51%(145/162),阳性预测值73.85%(48/65),阴性预测值96.03%(145/151),准确性89.35%(193/216),两种检查结果的一致性Kappa=0.734(P<0.05);CTCA结合CT首过心肌灌注成像诊断SMI的敏感性92.59%(50/54),特异性90.74%(147/162),阳性预测值76.92%(50/65),阴性预测值97.35%(147/151),准确性91.20%(197/216),两种检查结果的一致性Kappa=0.780(P<0.05)。结论 CTCA结合CT首过心肌灌注成像诊断SMI有较高的准确性,作为"一站式"诊断冠心病在临床中有很好的应用前景。
Objective To evaluate CTCA combined with CT first-pass myocardial perfusion imaging in diagnosing silent myocardial ischemia （SMI）. Methods 72 patients with suspected SMI were included in this study. Myocardial perfusion imaging （MPI） and CTCA were performed in all patients. Taking MPI as the reference standard, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CT first-pass myocardial perfusion imaging and CTCA combined with CT first-pass myocardial perfusion imaging in the diagnosis of SMI were evaluated, and the consistency with the diagnosis of MPI was analyzed. Results Technical success was achieved in all 72 cases. Compared with MPI, on patient-based level, the sensitivity, specificity, positive predictive value and negative predictive value of CT first-pass myocardial perfusion imaging in detecting SMI were 90.91% （40/44）, 71.43% （20/28）, 83.33 % （40/48） and 83.33% （20/24） respectively, the accuracy was 83.33% （60/72）. The consistency between CT first-pass myocardial perfusion imaging and MPI was evaluated with Kappa analysis, and Kappa value was 0. 640 （ P 〈 0.05 ）. The sensitivity, specificity, positive predictive value and negative predictive value of CTCA combined with CT first-pass myocardial perfusion imaging in detecting SMI were 95.45 % （42/44）, 75.00% （21/28）, 85.71% （42/49） and 91.30% （21/23） respectively, the accuracy was 87.50% （63/72）. The consistency between CTCA combined with CT first-pass myocardial perfusion imaging and MPI was evaluated with Kappa analysis, and Kappa value was 0. 728 （ P 〈 0. 05）. On vessel-based level, the sensitivity, specificity, positive predictive value and negative predictive value of CT first-pass myocardial perfusion imaging and CTCA combined with CT first-pass myocardial perfusion imaging in detecting SMI were 88.89% （48/54）, 89.51% （ 145/162）, 73.85% （48/65）, 96.03% （ 145/151 ） respectively and 92.59% （50/54）, 90.74% （ 147/ 162）, 76.92% （50/65）, 97.35% （ 147/151 ） respectively, with the diagnostic accuracy being 89.35% and 91.20% respectively. The Kappa values were 0. 734 and 0.780 respectively （ both P 〈 0.05 ）. Conclusion CTCA combined with CT first pass myocardial perfusion imaging in the diagnosis of SMI has a high accuracy, as the ＂one stop＂ examination of coronary heart disease has a good clinical application prospect.
出处
《医学影像学杂志》
2017年第4期635-639,共5页
Journal of Medical Imaging
关键词
心肌缺血
体层摄影术
X线计算机
心肌灌注显像
Myocardial ischemia
Tomography, X-ray computed
Myocardial perfusion imaging
