【作者】 閤谦；

【导师】 田建明； 孔令山；

【作者基本信息】 第二军医大学 ， 影像医学与核医学， 2008， 博士

【摘要】 第一部分缺血心肌动物模型（猪）PET、SPECT及组织学对比研究目的评估²⁰¹T1 SPECT及¹⁸F-FDG PET两种影像学方法对模型猪心肌活力地鉴别。方法选择健康家猪12头,其中10头于冠状动脉左旋支起始处放置Ameriod环,饲养28d形成慢性心肌缺血动物模型（另2头作正常对照）,行²⁰¹T1 SPECT心肌血流灌注显像和¹⁸F-FDG PET心肌代谢显像并与HE染色病理学改变进行比较。结果除1头模型猪实验中途意外死亡外,其余9头模型猪及2头正常猪均行²⁰¹T1SPECT心肌血流灌注显像检查及¹⁸F-FDG PET心肌代谢检查。在81个心肌节段中,²⁰¹T1 SPECT心肌灌注显像为固定缺损即SPECT显像示无心肌活力的19个节段中,¹⁸F-FDG PET显像显示有心肌活力的节段（灌注-代谢不匹配）为11个（参照附图3）,无心肌活力的节段（灌注-代谢匹配）为8个,²⁰¹T1 SPECT心肌灌注显像中负荷时缺损而静息时填充且得分增加1分或1分以上的节段为4个,¹⁸F-FDGPET均显示有活力,即在81个心肌节段中,¹⁸F-FDG PET示心肌无活力的节段为8个,示心肌有活力的节段为73个。¹⁸F-FDG PET心肌代谢显像示心肌有活力节段为73个（90.1%）明显高于²⁰¹T1 SPECT心肌血流灌注显像所示心肌有活力节段62个（76.5%）,经统计其差异有显著性（x²=5.37,p＜0.05）。结论¹⁸F-FDG PET检测心肌活性的准确性要高于²⁰¹T1 SPECT。本实验说明心肌葡萄糖代谢显像是判断心肌细胞是否存活的准确而灵敏的指标,是目前一种较可靠的检查手段。它对心肌存活患者血运重建后心脏事件和病死率的预测及左室功能的预期判断均具有很重要的临床指导意义。第二部分64层螺旋CT与PET显像检测急性心肌梗死患者心肌活性的对比研究目的以¹⁸F-FDG PET心肌代谢显像为标准,评价64层螺旋CT心脏延迟增强扫描在评估心肌活性的作用。方法20名急性心肌梗死的住院患者初次心梗发作2周内接受64层螺旋CT检查及PET检查。将左室心肌按照美国心脏学会推荐的方法分为17节段。逐个节段进行对比并用配对McNemar检验及诊断试验一致性检验进行统计分析。了解两种方法的一致性。结果本试验共包括20名患者,其中男性患者15名,女性患者5名。平均年龄60±13岁,平均心率为70±11次/分。前壁心肌梗死（n=8）,前间壁心肌梗死（n=3）,下壁心肌梗死（n=9）。左室心肌的17个节段中,有5段心肌两种方法检测结果完全一致。有10段心肌一致性好（Kappa值＞0.75）,有2段检测结果显示两种方法一致性较好（0.40≤Kappa值≤0.75）。结论本试验的结果告诉我们,两种方法在检测心肌活性方面具有一致性,且一致性好。PET显像不仅用于心肌缺血和心肌存活的诊断,而且在缺血性心脏病治疗决策中起重要的指导作用。但由于PET设备相对较少,费用较昂贵,限制了其临床应用。而64层螺旋CT检查费用相对低廉,分布相对广泛。它不仅具有极高的时间、空间、密度分辨率,也有先进的后处理软件和心电门控技术,64层螺旋CT心脏延迟增强扫描评价心肌存活性技术简便、无创,采集时间短,允许对带有金属泵及起搏器等金属植入物的病人进行检查,并可同时评价心功能和冠状动脉。随着CT设备时间分辨力的进一步提高,该技术将具有重要的临床应用前景。第三部分64层螺旋CT冠状动脉成像与冠状动脉造影的对比研究目的评价64层螺旋CT冠状动脉造影对冠状动脉明显狭窄诊断准确性和可行性。方法82例冠心病疑似患者在一周内进行了64层CT冠状动脉造影及常规血管造影,对冠状动脉的主干及主要分支进行诊断,以冠状动脉造影结果为金标准评价64层CT诊断冠状动脉狭窄的准确性。结果64层螺旋CT所显示的984支冠状动脉中冠状动脉狭窄102处,正确诊断197处,漏诊5处,误诊13处,灵敏性95.1%,特异性98.53%,阳性预测值88.18%,阴性预测值99.43%,准确率98.17%。结论64层螺旋CT对冠状动脉狭窄诊断有较高的准确性,可作为高危人群普查筛选的首选方法之一。更多还原

【Abstract】 Part 1An experimental animal model of Myocardial ischemic:study of positron emission tomography, single photon emission computed tomography and pathologyObjective To compare ²⁰¹T1 SPECT imaging for the assessment of myocardial viability with ¹⁸F-FDG PET imaging in pigs with chronic myocardial ischemic. Methods 9 animal models completed all examination successfully.²⁰¹T1 SPECT imaging and ¹⁸F-FDG PET imaging were performed on 9 pigs models of chronic myocardial ischemia induced with ameroid constrictors.The viable myocardial segments were determined by hemotoxylin and eosin staining to identify myocardial changes.Results In 81 myocardial segments,The viable myocardial segments which assessed by 18F-FDG PET imaging and 201T1 SPECT imaging were 73（90.1%） and 62（76.5%） respectively.The viable myocardial segments percentages were statistically different within one group（χ2=5.37,P＜0.05）.With HE staining,the viable myocardial segments were 74（91.3%）.Comparing with 18F-FDG PET imaging and HE staining,The viable myocardial segments percentages were not statistically different within one group（χ²=0.073,P＞0.05）.Conclusion Compared with ²⁰¹T1 SPECT imaging,¹⁸F-FDG PET imaging assesses viable myocardial more accurately.Part 2Comparison of 64-Slice CT and PET In Assessment Of Myocardial Viability Of Patients Acute Myocardial InfarctionObjective To evaluate the diagnostic value for myocardial viability by using late-enhancement 64-Slice Computed Tomography compared with ¹⁸F-FDG PET imaging in patients with Acute Myocardial Infarction.Methods Our study population comprised 15 men and 5 women.Mean age was 60±13 years.Myocardial infarction was anterior（n=8）,inferior（n= 9）,anterior and septal（n = 3）.20 patients admitted for a first acute myocardial infarction followed by 64-slice CT and ¹⁸F-FDG PET imaging.And the 17 myocardial segments of the left ventricle depicted by the American Heart Association.In order to determine the agreement of two methods,17 myocardial segments Data were analyzed respectively by McNemar test and Kappa test.Results Analysis of assessment of Myocardial Viability revealed best agreement between 5 myocardial segments（Kappa=1）,better agreement between 10 myocardial segments（Kappa＞0.75）and good agreement between 2 myocardial segments （0.40≤Kappa≤0.75 ）.Conclusions There was high agreement between two methods.Late-enhancement 64-Slice Computed Tomography is a promising method for assessment of Myocardial Viability.Part 3Comparison of 64-slice Computed Tomography And Conventional Angiography For Detecting Coronary Artery StenosiSObjective The aim of the present study was to evaluate the accuracy and feasibility of 64 slice spiral computed tomography（MSCT）in detecting coronary artery stenoses.Methods 82 patients 68 male,14 female;mean age（60.64±13.47）years with suspected coronary artery disease underwent coronary angiography and 64 slice CT（SOMATOM SENSAT10N CARDIAC64 CT,Siemens,Germany） The mean time span between coronary angiography（CAG） and CTA was 7 days.Evaluation of right coronary artery（RCA）,left main（LM）,left anterior descending artery（LAD）, diagonal branch 1（D1）,circumflex branch（CX）,and 1st marginal branch was performed by two.All vessels with a diameter≥1.5 mm were analysed and a lumen restriction of≥50%was considered a significant stenosis.Invasive coronary angiography was taken as gold standard for calculations of diagnostic accuracy.Results Of 984 segments,Compared with CAG,the sensitivity of CTA to diagnose significant stenosis was 95.1%,specificity98.53%,positive predictive value（PPV） 88.18%and negative predictive value（NPV） 99.43%.Conclusion Sixty-four MSCT has a high accuracy for the detection of significant coronary artery stenoses and therefore can be considered as a valuable noninvasive technique.更多还原