单光子发射计算机断层心肌灌注显像在左主干疾病诊断中的应用。
Single-photon emission computed tomography myocardial perfusion imaging in the diagnosis of left main disease.
机构信息
Division of Cardiology and Department of Internal Medicine, DetroitMedical Center, Wayne State University School of Medicine, Detroit, Michigan 48201, USA.
出版信息
Clin Cardiol. 2009 Dec;32(12):E11-5. doi: 10.1002/clc.20534.
BACKGROUND
Left main disease (LMD), defined as > or = 50% lesion stenosis, occurs in 3% to 5% of patients undergoing catheterization. Limited data on the value of single-photon emission computed tomography (SPECT) imaging for diagnosis of LMD exists.
HYPOTHESIS
This study sought to evaluate the diagnostic accuracy of SPECT imaging in the diagnosis of LMD.
METHODS
A total of 74 consecutive patients with LMD, identified from our catheterization lab database (January 2003-December 2007) with gated exercise (15 patients) or adenosine (59 patients), thallium 201, or Tc-99m SPECT imaging within 6 months of index angiography were included. Group 1 (Gp 1) included 33 patients with isolated LMD. Group 2 (Gp 2) consisted of 41 patients with LMD and 1-vessel disease (6); LMD and 2-vessel disease (24); and LMD and 3-vessel disease (11).
RESULTS
Reversible perfusion defects (PD) were absent in 6 (18%) of Gp 1 and 8 (20%) of Gp 2 patients. Among Gp 1 patients, PD in 1-vessel, 2-vessel, 3-vessel distribution were seen in 20 (61%), 5 (15%), and 2 (6%) patients respectively. In comparison, PD in 1-vessel, 2-vessel, 3-vessel distribution were observed in 20 (49%), 12 (29%), and 1 (2%) of Gp 2 patients respectively. Left main (LM) pattern was noted in 6 patients (Gp 1: 2, Gp 2: 4). Transient ischemic dilatation (TID) was encountered in 34 patients (Gp 1: 17, Gp 2: 17) and in 4 patients with normal perfusion scans.
CONCLUSIONS
These data represent the largest analysis of patients with "isolated" LMD. Approximately 19% of patients with LMD have no reversible PD on SPECT. While LM pattern is rare, 1-vessel distribution PD and TID represent the most frequent SPECT abnormalities.
背景
左主干病变（LMD）定义为 > 或 = 50%的狭窄病变，发生于 3%至 5%接受导管检查的患者中。关于单光子发射计算机断层扫描（SPECT）成像在诊断 LMD 中的价值，目前仅有有限的数据。
假设
本研究旨在评估 SPECT 成像在诊断 LMD 中的准确性。
方法
我们从导管实验室数据库（2003 年 1 月至 2007 年 12 月）中连续入选 74 例 LMD 患者，这些患者接受了门控运动（15 例）或腺苷（59 例）负荷试验、铊 201 或 Tc-99m SPECT 检查，检查时间均在冠状动脉造影后 6 个月内。第 1 组（Gp 1）包括 33 例孤立性 LMD 患者，第 2 组（Gp 2）包括 41 例 LMD 合并 1 支血管病变（6 例）、LMD 合并 2 支血管病变（24 例）和 LMD 合并 3 支血管病变（11 例）。
结果
Gp 1 中有 6 例（18%）和 Gp 2 中有 8 例（20%）患者的可逆性灌注缺损（PD）消失。在 Gp 1 患者中，1 支、2 支和 3 支血管分布的 PD 分别见于 20 例（61%）、5 例（15%）和 2 例（6%）患者。相比之下，Gp 2 患者中 1 支、2 支和 3 支血管分布的 PD 分别见于 20 例（49%）、12 例（29%）和 1 例（2%）患者。Gp 1 中有 6 例（2 例）和 Gp 2 中有 4 例（2 例）患者出现左主干（LM）图形。Gp 1 中有 17 例（Gp 2 中有 17 例）和 4 例灌注正常的患者出现短暂性缺血扩张（TID）。
结论
这些数据代表了最大的孤立性 LMD 患者分析。约 19%的 LMD 患者 SPECT 上无可逆 PD。尽管 LM 图形少见，但 1 支血管分布的 PD 和 TID 是最常见的 SPECT 异常。
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