Elhendy Abdou, Schinkel Arend F L, van Domberg Ron T, Bax Jeroen J, Valkema Roelf, Poldermans Don
Thoraxcenter, University Hospital Rotterdam, Rotterdam, The Netherlands.
Int J Cardiovasc Imaging. 2006 Oct;22(5):657-62. doi: 10.1007/s10554-006-9087-6. Epub 2006 Apr 21.
The aim of this study was to assess the accuracy of stress 99m technetium tetrofosmin myocardial perfusion imaging for the diagnosis of in stent stenosis (ISS).
We studied 72 patients who underwent exercise or dobutamine stress 99m technetium tetrofosmin imaging, 0.9+/-0.5 years after percutaneous coronary interventions in which stents were deployed. Coronary angiography was performed within 3 months of the stress test. ISS was defined as > or =50% stenosis in a coronary segment with previous stenting. Significant coronary artery disease (CAD) was defined as > or =50% stenosis within or outside the stented coronary segment.
The stent was deployed in 1 coronary artery in 52 patients, and in 2 coronary arteries in 20 patients (a total of 92 detected in 42 (58%) patients (51 stents). Reversible perfusion abnormalities were present in 34 of patients with ISS (sensitivity=81%, CI 70-94). Regional sensitivity for diagnosis of stenosis per stent was 76% (CI 65-88), specificity was 83% (CI 71-94) and accuracy was 79% (CI 69-85). Reversible perfusion abnormalities were detected in > or =2 vascular distributions in 15 of 22 patients with multi-vessel CAD and in 5 of 50 patients without (sensitivity for identifying multivessel CAD=68%, CI 50-89; specificity=90%, CI 82-98; and accuracy=83%, CI 75-90).
Stress 99m technetium tetrofosmin myocardial perfusion imaging is a useful non-invasive technique for the diagnosis of in stent stenosis and extent of CAD in patients with previous percutaneous coronary artery interventions.
本研究旨在评估锝-99m 替曲膦心肌灌注显像诊断支架内狭窄（ISS）的准确性。
我们研究了 72 例患者，这些患者在接受经皮冠状动脉介入治疗并植入支架后 0.9±0.5 年，进行了运动或多巴酚丁胺负荷锝-99m 替曲膦显像。在负荷试验后 3 个月内进行冠状动脉造影。ISS 定义为先前植入支架的冠状动脉节段狭窄≥50%。显著冠状动脉疾病（CAD）定义为支架置入的冠状动脉节段内或外狭窄≥50%。
52 例患者的 1 支冠状动脉植入了支架，20 例患者的 2 支冠状动脉植入了支架（共 42 例（58%）患者检测到 92 个支架）。ISS 患者中有 34 例出现可逆性灌注异常（敏感性=81%，可信区间 70-94）。每个支架诊断狭窄的局部敏感性为 76%（可信区间 65-88），特异性为 83%（可信区间 71-94），准确性为 79%（可信区间 69-85）。22 例多支血管 CAD 患者中有 15 例在≥2 个血管分布区域检测到可逆性灌注异常，50 例无多支血管 CAD 的患者中有 5 例检测到可逆性灌注异常（识别多支血管 CAD 的敏感性=68%，可信区间 50-89；特异性=90%，可信区间 82-98；准确性=83%，可信区间 75-90）。
锝-99m 替曲膦心肌灌注显像对于诊断既往接受经皮冠状动脉介入治疗患者的支架内狭窄及 CAD 范围是一种有用的非侵入性技术。
