Lin Shoa-Lin, Chiou Kuan-Rau, Huang Wei-Chun, Peng Nan-Jing, Tsay Daw-Guey, Liu Chun-Peng
Department of Internal Medicine, Division of Cardiology, Kaohsiung Veterans General Hospital, 386 Dar-Chung 1st Road, Kaohsiung, 813, Taiwan.
Heart Vessels. 2006 Jul;21(4):226-35. doi: 10.1007/s00380-005-0890-0.
Real-time myocardial contrast echocardiography (MCE) has the potential to evaluate myocardial perfusion and wall motion (WM) simultaneously. The purposes of this study were to correlate the diagnostic value of MCE with radionuclide single-photon emission computed tomography (SPECT), and to assess the sensitivity and specificity of real-time MCE in detecting coronary artery disease (CAD). Seventy patients with clinically suspected CAD underwent MCE and SPECT at baseline and after dipyridamole infusion. Segmental perfusion with MCE using low mechanical index after 0.3-0.4-ml bolus injections of perfluorocarbon exposed sonicated dextrose albumin solution was performed. All patients had a dual-isotope (rest thallium-201, stress sestamibi) study performed both at baseline and after dipyridamole infusion, and 40 patients had subsequent quantitative coronary angiography. Abnormalities were noted in 27 patients (38.6%) by MCE, in 29 patients (41.4%) by WM analysis, and in 30 patients (42.9%) by SPECT imaging. When MCE and WM analysis were combined, the agreement with SPECT imaging improved from 75.7% (Kappa = 0.50) to 82.0% (Kappa = 0.62). In 40 patients (120 territories) who underwent coronary angiography, good perfusion concordance was achieved for the left anterior descending and left circumflex arteries, and was fair for the right coronary arteries. Compared with quantitative angiography, there was no difference in sensitivity, specificity, and accuracy in detecting significant CAD among the three modalities. The combination of MCE and WM had a better sensitivity (84%), specificity (93.3%), and accuracy (87.5%) than the MCE and WM analysis alone. However, the difference did not reach statistical significance. Real-time MCE has a good agreement with SPECT imaging for detecting CAD. The combination of MCE and WM appears to have higher sensitivity, specificity, and accuracy in detecting CAD than either technique alone.
实时心肌对比超声心动图（MCE）有潜力同时评估心肌灌注和壁运动（WM）。本研究的目的是将MCE的诊断价值与放射性核素单光子发射计算机断层扫描（SPECT）相关联，并评估实时MCE检测冠状动脉疾病（CAD）的敏感性和特异性。70例临床怀疑患有CAD的患者在基线时以及双嘧达莫输注后接受了MCE和SPECT检查。在静脉推注0.3 - 0.4毫升全氟碳暴露超声处理的葡萄糖白蛋白溶液后，使用低机械指数进行MCE的节段性灌注。所有患者在基线时以及双嘧达莫输注后均进行了双同位素（静息铊 - 201，负荷 sestamibi）研究，40例患者随后进行了定量冠状动脉造影。MCE检测到27例患者（38.6%）异常，WM分析检测到29例患者（41.4%）异常，SPECT成像检测到30例患者（42.9%）异常。当MCE和WM分析相结合时，与SPECT成像的一致性从75.7%（Kappa = 0.50）提高到82.0%（Kappa = 0.62）。在40例接受冠状动脉造影的患者（120个节段）中，左前降支和左旋支动脉实现了良好的灌注一致性，右冠状动脉的一致性一般。与定量血管造影相比，三种检查方法在检测显著CAD方面的敏感性、特异性和准确性没有差异。MCE和WM联合检测的敏感性（84%）、特异性（93.3%）和准确性（87.5%）优于单独的MCE和WM分析。然而，差异未达到统计学意义。实时MCE在检测CAD方面与SPECT成像有良好的一致性。MCE和WM联合检测CAD的敏感性、特异性和准确性似乎高于单独使用任何一种技术。
