使用实时三维和二维心肌对比超声心动图评估腺苷负荷状态下的心肌灌注：与单光子发射计算机断层扫描的比较

Assessment of myocardial perfusion during adenosine stress using real time three-dimensional and two-dimensional myocardial contrast echocardiography: comparison with single-photon emission computed tomography.

作者信息

Abdelmoneim Sahar S, Bernier Mathieu, Dhoble Abhijeet, Moir Stuart, Hagen Mary E, Ness Sue Ann C, Abdel-Kader Samir S, Pellikka Patricia A, Mulvagh Sharon L

机构信息

Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA.

出版信息

Echocardiography. 2010 Apr;27(4):421-9. doi: 10.1111/j.1540-8175.2009.01026.x. Epub 2010 Mar 15.

DOI:10.1111/j.1540-8175.2009.01026.x

PMID:20331695

Abstract

OBJECTIVES

To evaluate diagnostic accuracy of adenosine two-dimensional and three-dimensional myocardial contrast echocardiography (2D- and 3D-MCE) compared with single-photon emission computed tomography (SPECT) for assessing myocardial perfusion.

METHODS

From January through August 2007, patients with known or suspected CAD who were referred for SPECT underwent simultaneous adenosine 2D-MCE and 3D-MCE (live and full volume [FV]). Perfusion and wall motion in 17 segments in the left anterior descending, left circumflex, and right coronary artery territories were analyzed.

RESULTS

We studied 30 patients: mean (SD) age, 72.6 (8.2) years; 19 (63%) men. Perfusion by SPECT was abnormal in 13 patients (43%). When comparing MCE with SPECT, sensitivity was comparable for 2D-MCE, 92%; live 3D-MCE, 91%; and FV 3D-MCE, 90%. Specificity was comparable for 2D-MCE, 75%; live 3D-MCE, 69%; and FV 3D-MCE, 79%. Agreement between live 3D-MCE and 2D-MCE was 92% (kappa[SE], 0.83 [0.17]) and between FV 3D-MCE and 2D-MCE, 88% (kappa[SE], 0.76 [0.13]). For eight patients in whom SPECT showed reversible defects, live 3D-MCE correctly identified defects in seven (88%), whereas FV 3D-MCE correctly identified them in five (63%) (P = 0.57).

CONCLUSION

Myocardial perfusion assessment is feasible by 3D-MCE with the advantage of rapid, facile acquisition and offline image manipulation.

摘要

目的

评估腺苷二维和三维心肌对比超声心动图（2D - MCE和3D - MCE）与单光子发射计算机断层扫描（SPECT）在评估心肌灌注方面的诊断准确性。

方法

2007年1月至8月，因已知或疑似冠心病而接受SPECT检查的患者同时接受腺苷2D - MCE和3D - MCE（实时和全容积[FV]）检查。分析左前降支、左旋支和右冠状动脉供血区域17个节段的灌注和壁运动情况。

结果

我们研究了30例患者，平均（标准差）年龄72.6（8.2）岁，男性19例（63%）。SPECT显示13例患者（43%）灌注异常。将MCE与SPECT比较时，2D - MCE的敏感性为92%，实时3D - MCE为91%，FV 3D - MCE为90%，三者相当。2D - MCE的特异性为75%，实时3D - MCE为69%，FV 3D - MCE为79%，三者相当。实时3D - MCE与2D - MCE之间的一致性为92%（kappa[标准误]，0.83[0.17]），FV 3D - MCE与2D - MCE之间为88%（kappa[标准误]，0.76[0.13]）。对于SPECT显示可逆性缺损的8例患者，实时3D - MCE正确识别出7例（88%），而FV 3D - MCE正确识别出5例（63%）（P = 0.57）。