^99mTcN-NOET MPI临床应用研究及图像质量影响因素分析

【作者】 卫华；

【导师】 李思进；

【作者基本信息】 山西医科大学 ， 内科学， 2010， 博士

【摘要】 第一部分99mTcN-NOET GSPECT心肌灌注显像的临床应用研究第一节99mTcN-NOET GSPECT MPI在原发性高血压病的临床应用目的：探讨99mTcN-NOET GSPECT运动+延迟心肌灌注显像(MPI)在原发性高血压患者中的临床应用价值。方法：高血压组：选择2007年5月-2010年1月在我科就诊的高血压患者60例,均符合1999年WHO/ISH的高血压诊断标准,男性38例,女性22例,年龄范围35-73岁,平均(54.10±10.42)岁,病程0.2-30年,平均(6.22士6.24)年。其中高血压1级有25例,2级有19例,3级有16例。其中有心绞痛症状的46例(76.7%),有19人行冠状动脉造影(31.7%),11人诊断为冠心病(狭窄≥50%为诊断标准),8例冠状动脉造影正常。正常对照组：志愿者19例,男性9例,女性10例,年龄范围25-58岁,平均年龄49.82±10.36岁。所有受检者行99mTcN-NOET负荷+延迟GSPECT心肌灌注显像,踏车运动,达终止指标时静脉注射740-1110 MBq99mTcN-NOET,15min后脂餐,30 min后行运动MPI,3小时行延迟MPI。所有的图像均经两名有经验的专业医师以双盲法进行分析判断。肉眼分析：将左室心肌分为9个节段,对图像结果进行节段性分析。对高血压组和对照组的MPI、心功能(EDV、ESV、EF)、侧壁／间壁比(L／S)、肺心比(LHR)、△EF=EF运动-EF延迟,TID(心腔一过性缺血扩大)进行对比分析。结果：1、①高血压组有40%(24／60)有高血脂,43.3%(26／60)有高血压家族史,明显高于对照组(0%vsl 5.8%,P<0.05)；高血压组60例,心绞痛发生率76.7%(46／60),36.7%(22／60)运动ECG呈阳性,其中20例为ST-T改变,2例为房性早搏和室性早搏,26.7%(15／60)运动中出现胸闷,21.7%(13／60)运动中血压过度反应；对照组19例,心绞痛发生率0%(0／19),10.5%(2／19)运动ECG阳性,5.3%(1/19)运动中胸闷,无1例(0%,0/19)运动血压过度反应。②高血压组有4例运动EF小于50%,延迟均恢复正常,另有2例运动EF正常,延迟EF小于50%；正常对照组有1例运动正常,延迟EF小于50%。而所有受试者室壁活动均正常。运动和延迟EDV、ESV、EF两组之间均无统计学差异。高血压组和对照组的△EF(1.00(8.00)vs 2.00(8.00),P＞0.05)和TID(0.98(0.11)vs 0.95(0.16),P＞0.05)比较均无统计学差异。△EF为负值的高血压组有28例(46.7%),对照组有4例(21.1%),P=0.047。③高血压组：19例(31.7%,19／60)出现心肌灌注异常,共计26(26／540,4.81%)个节段,其中21个节段(21／26,80.8%)为可逆性缺损,2个节段(2／26,7.7%)为部分可逆性缺损,2个节段(2／26,7.7%)为固定性缺损,1个节段(1／26,3.8%)为反向分布,26节段灌注图像的累计运动评分为59,延迟评分为24。对照组：1例、1个节段(5.3%,1／19；0.01%,1／171)心肌灌注显像提示可逆性缺损,运动评分为2,延迟评估分为1；高血压组心肌灌注阳性率明显高于对照组(31.75%,19／60 vs 5.3%,1／19,P<0.05)。④高血压组和对照组运动和延迟的肺心比(LHR)均无统计学差异(运动LHR：0.49±0.12 vs 0.47±0.08,P＞0.05；延迟LHR：0.48±0.11 vs 0.46±0.11,P＞0.05),运动和延迟L／S比在高血压组和对照组均无统计学差异(运动L／S：1.07±0.11 vs 1.08±0.12,P＞0.05；延迟L／S:1.06±0.11 vs 1.08±0.10,P>0.05)。2、①高血压MPI(+)组有19例,MPI(-)有41例,高血压MPI(+)组10例(52.6%,10/19)运动中胸闷,MPI(-)组5例(12.2%,5／41)运动中胸闷,两组有统计学差异(P=0.001)。②运动和延迟EDV、ESV及EF在高血压患者中MPI(+)与MPI(-)两组中均无统计学差异(P＞0.05)；△EF(-0.37±6.64 vs 2.51±7.58)和TID(0.96(0.14)vs 0.99(0.23))在MPI阳性和阴性组之间无统计学差异(P>0.05),MPI(+)的高血压患者中△EF为负值的例数11(11／19,57.9%),MPI(-)的高血压患者中△EF为负值的例数是12(12／41,29.3%),两者比较,P=0.034,有统计学差异。③运动LHR(0.51±0.10 vs 0.49±0.13,P＞0.05)和延迟LHR(0.47±0.09 vs 0.48±0.12,P＞0.05)在MPI(+)和MPI(-)的高血压患者中均无统计学差异,运动L／S(1.08±0.14 vs 1.07±0.10,P＞0.05)和延迟L／S(1.05±0.13 vs 1.06±0.09,P>0.05)在高血压MPI(+)和MPI(-)两组中均无统计学差异,对于再比值(1.02±0.11vsl.02±0.09,P>0.05)两组之间也无统计学差异。3、①运动中血压反应中高血压3级(43.8%,24.0%,5.3%,P=0.027)的血压反应明显高于高血压1级和2级,②不同级别高血压患者的运动和延迟的EDV、ESV和EF均无统计学差异(P>0.05)。心脏储备功能指标△EF和TID在3组之间无统计学差异。③运动和延迟LHR在3组高血压之间均无统计学差异,运动L／S值和延迟L／S值,及再比值在不同级别的高血压患者中均无统计学差异(P＞0.05)。4、有19例行冠状动脉造影,11例冠脉造影异常(狭窄≥50%为诊断标准),8例正常；心肌灌注显像,9例心肌灌注显像异常,10例正常。经统计可知，χ2=0.25,P=0.625,99mTcN-NOET GSPECT MPI的灵敏度、特异性、阳性预测值、阴性预测值分别为：72.7%、87.5%、88.9%、70.0%。符合率为78.9%。结论：②99mTcN-NOET运动+延迟心肌灌注显像可用于诊断高血压CAD患者。②99mTcN-NOET运动+延迟心肌灌注显像可用于评价高血压患者心脏储备功能,高血压患者的心脏储备功能低于正常对照。同时MPI(+)较MPI(-)的高血压患者心脏储备功能降低。③高血压患者血压的高低可能对99mTcN-NOET显像剂肺摄取有一定的影响作用。第一部分第二节99mTcN-NOET GSPECT MPI在2型糖尿病的临床应用目的：探讨99mTcN-NOET GSPECT运动+延迟心肌灌注显像(MPI)在2型糖尿病中的临床应用价值。方法：糖尿病组：2型糖尿病患者22例，均符合1999年WHO的糖尿病分类及诊断标准,并能行踏车运动。男18例,女4例,年龄37-72岁,平均(53.09±9.42)岁,病程1-21年,平均(5.91±5.06)年。经生化、酶学、超声心动图等检查排除了心肌梗死、高血压、风湿性心脏病、心肌炎、心肌病等疾患。其中有心绞痛症状的14例(63.6%),有3人行冠状动脉造影(31.7%),2人诊断为冠心病(狭窄≥50%为诊断标准),1例冠状动脉造影正常。对照组同前。所有患者行99mTcN-NOET GSPECT运动+延迟心肌灌注显像,检查前皆停用扩张冠状动脉药物、钙通道阻滞剂及p受体阻滞剂24 h。对糖尿病组和对照组的MPI、心功能(EDV、ESV、EF)、ΔEF、TID、L/S、LHR、进行对比分析。结果：①高血脂和饮酒在两组之间有统计学差异。糖尿病患者中伴高血脂的发病率也较高,血糖代谢异常引起血脂的异常有关。吸烟和家族史在两组之间无统计学差异。糖尿病组22例,心绞痛发生率63.6%(14／22),运动ECG呈阳性有8例(36.6%,8／22),其中7例为ST-T改变,1例为室性早搏,运动中出现胸闷胸痛有7例(31.8%,7／22),运动中血压过度反应有2例(9.1%,2／22)；对照组同前。糖尿病组发生心绞痛的比对照组多(63.6%vs 0.0%,P=0.000),运动中出现胸痛胸闷的也较高(31.8%vs 5.3%,P=0.05)。②糖尿病组有1例运动EF小于50%,运动EF=35%,延迟EF=39%。运动和延迟EDV、ESV、EF在两组之间均无统计学差异。但从数值上看,糖尿病组运动EDV和ESV略大于对照组(运动EDV：86.00(31.75)vs 73.00(32.00),P>0.05；运动ESV：35.50(19.50)vs 24.00(11.00),P>0.05),EF略小于对照组(61.32±10.19 vs 66.42±1.55,P＞0.05)；而糖尿病组延迟的EDV和ESV仍略大于对照组(运动EDV：91.45±25.60 vs 82.89±4.96,P＞0.05；运动ESV：38.32±15.89 vs31.42±3.06,P>0.05),EF略小于对照组(59.59±8.78 vs 63.16±7.54,P>0.05)。糖尿病组和对照组的△EF(1.73±6.42 vs 3.26±6.75,P>0.05)和TID(0.93±0.12 vs 0.95±0.11,P>0.05)比较均无统计学差异。统计△EF为负值的糖尿病组有10例(45.5%),对照组有4例(21.1%),P=0.100,认为糖尿病组心脏储备功能与对照组无统计学差异。③糖尿病组：8例(36.4%,8／22)出现心肌灌注异常,共计11(11/198,5.6%)个节段,其中6个节段(6／11,54.5%)为可逆性缺损,2个节段(2/11,18.2%)为固定性缺损,11个病变节段灌注图像的累计运动评分为27,延迟评分为11；对照组同前。糖尿病组心肌灌注阳性率明显高于对照组(36.4%,8／22；5.3%,1/19,P=0.016)。④糖尿病组运动LHR明显高于对照组(0.52±0.06 vs 0.47±0.08,P=0.024),延迟LHR在两组之间没有明显差异(0.48±0.58 vs 0.46±0.11,P=0.501)。运动L／S(1.08±0.13 vs 1.08±0.12,P>0.05)和延迟L／S(1.08±0.11 vs 1.08±0.10,P＞0.05)及再比值(0.99±0.09 vs 0.99±0.84,P>0.05)在糖尿病组和对照组均无统计学差异。结论：①99mTcN-NOET SPECT心肌灌注显像可用于糖尿病心肌缺血的诊断,糖尿病组心肌显像阳性率明显高于对照组。②糖尿病患者运动后肺摄取NOET明显增高,可能是心脏储备功能减低的征象。第一部分第三节99mTcN-NOET GSPECT MPI在高血压合并糖尿病患者的临床应用目的：探讨99mTcN-NOET GSPECT运动+延迟心肌灌注显像(MPI)在高血压病合并糖尿病患者中的临床应用价值。方法：高血压+糖尿病(HBP+DM)患者11例。男性9例,女性2例,年龄38-70岁,平均(52.00±9.35)岁。经生化、酶学、超声心动图等检查排除了心肌梗死、风湿性心脏病、心肌炎、心肌病等疾病。所有患者行99mTcN-NOET GSPECT运动+延迟心肌灌注显像,检查前皆停用扩张冠状动脉药物、钙通道阻滞剂及p受体阻滞剂24 h。其中有心绞痛症状的7例(63.6%),其中有1人行冠状动脉造影(9.1%),冠状动脉造影结果正常。对照组同第一部分第一节。对HBP+DM组和对照组的MPI、心功能(EDV、ESV、EF)、侧壁／间壁比(L／S)、肺心比(LHR)、ΔEF、TID(心腔一过性缺血扩大)进行对比分析。结果：①高血脂在两组之间有统计学差异(81.8% vs 0%, P<0.05)。HBP+DM组11例,心绞痛发生率81.8%(9／11),7例(63.3%,7/11)运动ECG呈阳性,其中7例为ST-T改变,2例(18.2%,2／11)运动中出现胸闷胸痛,6例(54.5%,6／11)运动中血压过度反应；对照组同前。HBP+DM组发生心绞痛、运动中ECG异常和运动中血压反应异常均比对照组高(P<0.05)。②HBP+DM组中EF值均正常。运动和延迟EDV、ESV、EF在两组之间均无统计学差异(P>0.05)。③HBP+DM组：5例(45.5%%,5／11)出现心肌灌注异常,共计5(5／99,5.1%)个节段,其中4个节段(4／5,80.0%)为可逆性缺损,1个节段(1／5,20.0%)为固定性缺损,5个病变节段灌注图像的累计运动评分为21,延迟评分为5；对照组同前。HBP+DM组心肌灌注阳性率明显高于对照组(45.5%,5/11; 5.3%,1/19, P=0.008)。HBP+DM和对照组的△EF(5.00±7.64 vs 3.26±6.75,P＞0.05)和TID(0.93±0.09 vs 0.95±0.11,P>0.05)比较均无统计学差异。同时统计△EF为负值的HBP+DM有3例(27.3%),对照组有4例(21.1%),P=0.698,认为HBP+DM组心脏储备功能与对照组无统计学差异。④运动LHR(0.49±0.10 vs 0.47+0.08,P>0.05)和延迟LHR(0.49±0.10 vs 0.46±0.11,P>0.05)在两组之间没有明显差异,运动L／S比(1.01±0.10 vs 1.08±0.12,P>0.05)及再比值(1.03±0.15 vs0.99±0.84,P>0.05)在HBP+DM组和对照组均无统计学差异延迟L／S比HBP+DM组明显低于对照组(0.99±0.14 vsl.08±0.10,P=0.047)。结论：99mTcN-NOET SPECT心肌灌注显像可用于高血压合并糖尿病患者心肌缺血的诊断,高血压合并糖尿病患者组心肌显像阳性率明显高于对照组。第二部分99mTcN-NOET GSPECT心肌灌注显像肺摄取的相关影响因素分析目的：对99mTcN-NOET GSPECT心肌灌注显像的肺心比值(LHR)的相关因素进行多元线性回归的分析,找出影响肺摄取的相关因素。方法：回顾2005年5月-2010年1月期间,在我科行99mTcN-NOET负荷+延迟门控心肌灌注断层显像的可疑和(或)确诊的冠心病患者172例,男性112例,女性60例,年龄范围25-75岁,平均年龄(50.81±11.20)岁。采用流行病学分析方法对所检测指标进行筛选，建立所测量指标和肺摄取多元线形回归模型。所测指标有：性别、年龄(岁)、心绞痛史、运动中心电图是否异常、运动中是否发生胸痛胸闷,运动级别、是否达次极量、血脂高低、是否吸烟、是否饮酒、高血压级别、高血压病年限、有无糖尿病、糖尿病年限、运动EDV、ESV、EF和延迟EDV、ESV、EF,及ΔEF、TID、病变节段数、运动L／S,延迟L／S,再比值。结果：①运动LHR与烟1(Bi=0.115,t=3.198,P<0.05)、烟1(Bi=0.175,t=5.565，P<0.05)、运动侧间比(Bi=0.081,t=2.582,P<0.05)、运动中胸痛(Bi=0.081,t=2.582,P<0.05)、血压分级2(Bi=-0.082,t=-1.98,P<0.05)有相关因素。②延迟LHR与烟2(Bi=0.153,t=4.96,P<0.05)、延迟评分(Bi=0.022,t=2.609,P<0.05)、运动中胸痛(Bi=0.073,t=2.249,P<0.05)有相关因素。结论：①受试者吸烟、运动侧间比、运动中胸痛、血压分级指标对运动LHR有影响。②受试者吸烟、延迟评分、运动中胸痛指标对延迟LHR有影响。第三部分X线衰减校正对99mTcN-NOET SPECT心肌灌注显像的临床应用目的：评价X线衰减校正对99mTcN-NOET SPECT心肌灌注显像的前后变化的临床应用价值。方法：对54例(男性38例,女性16例,年龄范围29-82岁,平均年龄(51.69±11.38)岁)可疑冠心病患者的102例次MPI(负荷49例次,延迟或静息53例次)X线衰减校正前后MPI的图像改变,通过计算20节段的放射线性分布百分比及评分、5节段的放射性分布百分比进行比较,及两位医生对下后壁NC和联合AC后前后一致性的Kappa值进行比较,同时对不同性别X校正前后的差异进行比较。结果：①心肌断层图像分析：心肌灌注显像X线衰减校正后可是图像质量明显提高,尤其对下后壁的校正作用,肝脏与心肌下壁太近或重叠的,表现为显像剂过度浓聚的现象。②MPI靶心图20节段分析：放射性分布百分比在15个节段有统计学差异(P<0.05),除前壁基底部,其余各壁全部有差异,心尖、前壁AC后放射性分布百分比是降低,差异显著(P<0.05),下后壁、近下后壁的侧壁和间隔放射性分布百分比增加,差异显著(P<0.05)；评分在6个节段有统计学差异(P<0.05),分布在心尖前部评分明显增加(P<0.05),下后壁评分明显降低(P<0.05)；对应节段的累积评分比较,可得心尖前部累积评分增加(9,13),下后壁的累积评分降低(15、16、16、11、7；2、0、3、3、6)。③MPI靶心图5节段分析：在心尖和前壁放射性分布百分比减低, AC对心尖和前壁的放射性分布减低的作用,但对心尖较明显(P<0.001)；侧壁、下后壁、间隔AC后放射性分布增加,下后壁和间隔节段有统计学差异(P<0.001)。④靶心图20节段,男性有统计学差异的心肌节段与总体的心肌差异节段基本相似,主要分布下后壁及近下后壁的侧壁和间壁,其它各壁散在分布；而对于女性来说,有差异的心肌节段主要分布两个重点区域,第一为下后壁区,另一个分布在心尖和近心尖的前壁区域；靶心图5节段,放射性分布百分比在总体、男性组和女性组之间的总的差异不大,出现在心尖、下后壁和间壁,而女性组中间壁区域无统计学差异,而与20节段的心肌节段分类法的无明显差异。⑤Kappa值：对NC的图像进行判读时的Kappa值为0.35,而联合上AC图像,Kappa值为0.64, Kappa值明显提高,可见一致性增高,且前后判读有统计学差异,表明AC和NC图像联合判读,可以提高医师对图像诊断的一致性。结论：①X线衰减校正,能够明显改善99mTcN-NOET心肌灌注显像图像的质量；②X线衰减校正后,能够明显提高99mTcN-NOET SPECT心肌灌注显像诊断的准确性；③肝影距心肌下后壁较近的,AC后下后壁过度校正并与肝影重叠；④X线衰减校正后,可以对下后壁的软组织衰减有显著校正作用,减低下后壁的假阳性,但同时对心尖及部分前壁有矫枉过正的现象,心尖及部分前壁显像剂分布稀疏,增加心肌及部分前壁的假阳性；⑤衰减校正前后,心肌各节段的放射性分布百分比差异范围较前后评分的差异范围大,放射性分布比分比为相对值,评分应该较其准确性高；⑥99mTcN-NOET SPECT心肌灌注显像X线衰减校正男性主要影响下后壁,而女性除下后壁外还有前壁。更多还原

【Abstract】 Part 1.1 Clinical Application of 99mTcN-NOET GSPECT Myocardial Perfusion Imaging in Primary HypertensionObjective:To explore clinical application value of the 99mTcN-NOET GSPECT myocardial perfusion imaging in patients with primary hypertension.Methods:hypertension(G1):Select 60 patients with hypertension in our department, who are in line with 1999 WHO/ISH hypertension diagnostic criteria,38 males,22 women, age range 35-73 years old, the average (54.10±10.42) years, duration of 0.2-30 years, average (6.22±6.24) years. Grade 1 of hypertension is 25 cases, grade 2 is 19 cases, grade 3 has 16 cases. All patients performed 99mTcN-NOET exercise+delay GSPECT myocardial perfusion imaging, including 46 patients with symptoms of angina (76.7%),19 were coronary angiography (31.7%),11 were diagnosed with coronary heart disease (stenosis≥50% of the diagnostic criteria),8 cases with normal coronary arteries. The normal control group (G2):Volunteers,19 patients,9 males,10 females, age range 25 to 58 years, with an average age of 49.82±10.36 years old. All subjects underwent treadmill exercise, reaching the termination of indicators intravenous 740-1110 MBq99mTcN-NOET,15min after the fat meal,30 min exercise MPI,3 hour delayed MPI. All the images were characterized by two experienced professional doctors to double-blind method for analysis to determine. Visual analysis:the left ventricular myocardium is divided into nine segments, the results of segmental analysis of the image. High blood pressure group and control group, MPI, cardiac function (EDV, ESV, EF), later/septal ratio (L/S), lung heart ratio (LHR),ΔEF= EFexercise-EFdelay, TID (Transient ischemic dilation ratio) were analyzed.Results:1、①hypertension group,24 cases (24/60,40%) had high blood lipids,26 patients (26/60,43.3%) had family history of hypertension was significantly higher (0,0% vs 15.8% P <0.05); Group of 60 patients with hypertension, angina pectoris incidence of 76.7%(46/60), 36.7%(22/60) exercise ECG positive, of whom 20 were ST-T changes,2 cases of atrial premature beats and ventricular premature beats,26.7%(15/60) exercise in the chest tightness, and 21.7%(13/60) the exercise of excessive blood pressure response; control group,19 cases, angina pectoris incidence of 0%(0/19),10.5%(2/19) exercise ECG positive,5.3%(1/19) campaign chest tightness, no 1 (0%,0/19), excessive blood pressure response to exercise.②hypertensive group, four cases of exercise EF less than 50%, delays were normal, and another two cases of exercise EF are normal, delayed EF less than 50%; the normal control group 1 cases of delay EF less than 50%. and delayed EDV, ESV, EF was no statistical difference between the two groups. Hypertension group and control groupΔEF (1.00 (8.00) vs 2.00 (8.00), P>0.05) and TID (0.98 (0.11) vs 0.95 (0.16), P>0.05) compared no statistical difference.ΔEF hypertension group was negative in 28 cases (46.7%), the control group,4 cases (21.1%), P=0.047.③hypertension group:19 cases (31.7%,19/60) appear myocardial perfusion abnormalities, a total of 26 (26/540,0.00%) segments,21 segments (21/26,80.8%) were reversible defects, two segments (2/26,7.7%) were part of the reversible defect,2 segments (2/26,7.7%) of fixity defect,1 segment (1/26,3.8%) were reverse distribution,26 segment perfusion image total motor score was 59, delayed score of 24. Control group:1 case,1 segment (5.3%,1/19 vs 0.01%,1/171) myocardial perfusion imaging tips reversible ischemia, exercise score of 2, delayed assessment is divided into 1; hypertension myocardial The positive rate of perfusion was significantly higher (31.75%,19/60 vs 5.3%,1/19, P＜0.05).④hypertension group and control group movement and delayed lung heart ratio (LHR) had no statistically significant difference (Exercise LHR:0.49±0.12 vs 0.47±0.08, P>0.05; delay LHR:0.48±0.11 vs 0.46±0.11, P>0.05), Exercise and delayed L/S than in the hypertensive group and the control group had no statistically significant difference (exercise L/S:1.07±0.11 vs 1.08±0.12, P> 0.05; delayed L/S:1.06±0.11 vs 1.08±0.10, P>0.05).2、③hypertension MPI (+) group were 19 patients, MPI (-)group were 41 cases. Smoking of the two groups was statistically different (22 (53.7%),5 (26.3%), P= 0.048).②Hypertension MPI (+) 10 cases (52.6%,10/19) campaign chest tightness; while hypertension MPI (-) 5 cases (12.2%,5/41) campaign chest tightness, there is significant difference between the two groups (P=0.001).③Exercise EDV, ESV, and EF and delay EDV, ESV and EF in hypertensive patients with MPI (+) and MPI (-) in both groups had no statistical difference (P> 0.05);ΔEF (-0.37±6.64,2.51±7.58) and TID (0.96 (0.14),0.99 (0.23)) in the positive and negative myocardial perfusion imaging was no significant difference between groups (P>0.05), MPI (+) in hypertensive patientsΔEF for the number of negative cases 11 (11/19,57.9%), MPI (-) inΔEF in hypertensive patients with a negative number is 12 cases (12/41,29.3%), comparison between the two, P=0.034, there are statistically significant.③Exercise LHR (0.51±0.10 vs 0.49±0.13, P> 0.05) and delayed LHR (0.47±0.09 vs 0.48±0.12, P> 0.05) in the MPI (+) and MPI (-) in hypertensive patients with no statistical learning differences, Exercise L/S (1.08±0.14 vs 1.07±0.10, P>0.05) and delayed L/S (1.05±0.13 vs 1.06±0.09, P>0.05) in hypertensive MPI (+) and MPI (-) There was no significant difference in both groups, for re-ratio (1.02±0.11 vs 1.02±0.09, P> 0.05) and no statistically significant difference between the two groups.3、①movement blood pressure response in hypertensive 3 (43.8%,24.0%,5.3%, P= 0.027) blood pressure of the blood pressure response was significantly higher than 1 and 2,②different levels of movement in patients with hypertension EDV, ESV, and EF and delay the EDV, ESV and EF were no statistically significant difference (P> 0.05). Cardiac reserve function parameters ΔEF, and TID 3 was no significant difference between groups.③Exercise and delayed LHR in the three groups had no statistically significant difference between high blood pressure, exercise L/S values and delayed L/S value, and re-ratio at different levels in hypertensive patients with no significant difference (P>0.05).④19 underwent coronary angiography,11 cases of abnormal coronary angiography (stenosis≥50% for major diagnostic criteria),8 cases of normal; myocardial perfusion imaging, myocardial perfusion imaging abnormalities in 9 cases,10 cases of normal. The statistics we can see,χ2= 0.25, P=0.625,99mTcN-NOET GSPECT MPI sensitivity, specificity, positive predictive value, negative predictive value were:72.7%,87.5%, 88.9%,70.0%.Conclusion:②99mTcN-NOET exercise+delayed myocardial perfusion imaging can be used to diagnose CAD in patients with hypertension.②99mTcN-NOET exercise+delayed myocardial perfusion imaging can be used to evaluate cardiac function in patients with hypertension; cardiac functional was lower patients with hypertension than normal controls. MPI (+) compared with MPI (-) in hypertensive patients was reduced cardiac functional.③the level of blood pressure in hypertensive patients may have a certain effect for 99mTcN-NOET imaging agent for lung uptake Part 1.2 Clinical Application of 99mTcN-NOET GSPECT Myocardial Perfusion Imaging in Type 2 DiabetesObjective:To explore clinical application value of the 99mTcN-NOET GSPECT exercise+stress myocardial perfusion imaging in patients with type 2 diabetes.Methods:Diabetic group:22 cases of patients with type 2 diabetes are in line with 1999 WHO classification and diagnostic criteria of diabetes, and can do treadmill exercise. Male 18 and 4 female, aged 37 to 72 years, the average (53.09±9.42) years, duration of 1-21 years, the average (5.91±5.06) years. The biochemistry, enzymology, echocardiography and other tests ruled out myocardial infarction, hypertension, rheumatic heart disease, myocarditis, heart disease and other disorders. Among them 14 patients with symptoms of angina (63.6%),3 People’s Bank of coronary angiography (31.7%),2 were diagnosed with coronary heart disease (≥50% for the narrow diagnostic criteria),1 patient with normal coronary arteries. Control group, with the former. All patients with 99mTcN-NOET GSPECT exercise+delayed myocardial perfusion imaging, check out before the expansion of both coronary drugs, calcium channel blockers, and P-blockers 24 h. In diabetic group and control group, MPI, cardiac function (EDV, ESV, EF),ΔEF, TID, L/S, LHR, to conduct comparative analysis.Results:①high blood cholesterol and alcohol consumption were statistically different between the two groups. Diabetic patients with high cholesterol have a higher incidence of glucose metabolic disorder caused by blood lipid abnormalities. Smoking and family history between the two groups no statistical difference. Diabetic group,22 cases, the incidence of angina pectoris 63.6%(14/22), exercise ECG positive,8 cases (36.6%,8/22), of which 7 cases of ST-T changes, 1 case of premature ventricular contractions, campaign chest tightness chest pain in 7 cases (31.8%,7/22), the movement of blood pressure over-reaction of two cases (9.1%,2/22); control group with the former. Diabetic patients with angina pectoris occurred more than in the control group (63.6% vs 0.0%, P= 0.000), chest tightness and movement of the chest pain was also higher (31.8% vs 5.3%, P= 0.05).②Diabetic group 1 cases of exercise EF less than 50%, sports EF= 35%, did not return to normal after 3 hour3, delayed EF= 39%. Stress and delayed EDV, ESV, EF was no statistical difference between the two groups. However, from numerical point of view, the diabetic group exercise EDV and ESV slightly larger than the control group (exercise EDV:86.00 (31.75) vs 73.00 (32.00), P> 0.05; exercise ESV:35.50 (19.50) vs 24.00 (11.00), P> 0.05), EF is slightly lower than the control group (61.32±10.19 vs 66.42±1.55, P> 0.05); while the diabetic group delay EDV and ESV are still slightly larger than the control group (exercise EDV:91.45±25.60 vs 82.89±4.96, P>0.05; exercise ESV:38.32±15.89 vs 31.42±3.06, P>0.05), EF is slightly lower than the control group (59.59±8.78 vs 63.16±7.54, P> 0.05). Diabetic group and control groupΔEF (1.73±6.42 vs 3.26±6.75, P> 0.05) and TID (0.93±0.12 vs 0.95±0.11, P> 0.05) compared no statistical difference. StatisticsΔEF was negative in 10 cases of diabetic group (45.5%), the control group,4 cases (21.1%), P= 0.100, that the cardiac reserve function and diabetic control group, no statistical difference.③diabetic group:8 cases (36.4%,8/22) appeared myocardial perfusion abnormalities, a total of 11 (11/198,5.6%) segments, of which 6 segments (6/11,54.5%) were reversible defect,2 segments (2/11,18.2%) of solidity defects,11 segments lesions perfusion image total motor score of 27, delayed score was 11; the control group with the former. Diabetic group was significantly higher positive rate of myocardial perfusion (36.4%,8/22 vs 5.3%,1/19, P=0.016).④Diabetic group was significantly higher LHR movement (0.52±0.06 vs 0.47±0.08, P=0.024), delay LHR there is no significant difference between the two groups (0.48±0.58 vs 0.46±0.11, P= 0.501). Stress L/S (1.08±0.13 vs 1.08±0.12, P> 0.05) and delayed L/S (1.08±0.11 vs 1.08±0.10, P> 0.05) and re-ratio (0.99±0.09 vs 0.99±0.84, P> 0.05) in the diabetic group and control group were not statistically significant.Conclusion:①99mTcN-NOET SPECT myocardial perfusion imaging can be used for the diagnosis of myocardial ischemia in diabetes, diabetic group was significantly higher positive rate of myocardial perfusion imaging.(2)Diabetic patients with lung uptake after exercise was significantly higher NOET may be signs of reduced cardiac functional reserve. Part1.3 Clinical Application of 99mTcN-NOET GSPECT MPI in Hypertensive Patients with Diabetes MellitusObjective:To explore the 99mTcN-NOET GSPECT exercise+stress myocardial perfusion imaging (MPI) in hypertensive patients with diabetes in the clinical application.Methods:Hypertension+diabetes mellitus (HBP+DM) patients with 11 cases.9 cases of male and 2 female, aged 38 to 70 years with an average (52.00±9.35) years of age. The biochemistry,enzymology, echocardiography and other tests ruled out myocardial infarction, rheumatic heart disease, myocarditis, cardiomyopathy and other diseases. All patients with 99mTcN-NOET GSPECT Exercise+delayed myocardial perfusion imaging, check out before the expansion of both coronary drugs, calcium channel blockers, andβ-blockers 24 h. Including angina symptoms in 7 patients (63.6%), including a People’s Bank of coronary angiography (9.1%), coronary angiography and normal. Control group, with the first part of the section.Results:①high blood lipids statistical difference between the two groups (81.8% vs 0%, P＜0.05). HBP+DM patients with a higher incidence of high blood lipids, blood glucose, blood pressure and lipid abnormalities consistent with metabolic syndrome features. HBP+DM group of 11 patients, the incidence of angina pectoris was 81.8%(9/11),7 cases (63.3%,7/11) tested positive for exercise ECG, of which 7 cases were ST-T changes in 2 cases (18.2%,2/11) campaign chest tightness chest pain,6 cases (54.5%,6/11) the movement of blood pressure over-reaction; control group, with the former. Available from the table, HBP+DM group of angina, ECG abnormal movements and campaigns in the abnormal blood pressure response than those in control group (P＜0.05).②HBP+DM group, EF values were normal. Exercise and delayed EDV, ESV, EF was no significant difference between the two groups (P> 0.05).③HBP +DM group:5 cases (45.5%%,5/11) appeared myocardial perfusion abnormalities, a total of 5 (5/99,5.1%) segments, of which four segments (4/5,80.0%) were reversible defect, a segment (1/5,20.0%) of fixity defects, five lesions perfusion segments of the cumulative movement the image score of 21, delayed score of 5; control group, with the former. The positive rate of myocardial perfusion in hypertensive group was significantly higher (45.5%,5/11 vs 5.3%,1/19, P=0.008). Diabetic group and control groupΔEF (5.00±7.64 vs 3.26±6.75, P>0.05) and TID (0.93±0.09 vs 0.95±0.11, P>0.05)) compared no statistical difference. At the same time statisticsΔEF was negative in 3 cases of hypertension group (27.3%), the control group,4 cases (21.1%), P=0.698, that the HBP+DM group of cardiac reserve function and the control group no statistical difference.④exercise LHR (0.49±0.10 vs 0.47±0.08, P>0.05) and delayed LHR (0.49±0.10 vs 0.46±0.11, P>0.05) was not significantly different between the two groups, exercise L/S ratio (1.01±0.10 vs 1.08±0.12, P>0.05) and re-ratio (1.03±0.15 vs 0.99±0.84, P>0.05) in the HBP+DM group and the control group had no statistical difference in delay L/S ratio HBP+DM group was significantly lower than that the control group (0.99±0.14 vs 1.08±0.10,P=0.047).Conclusion:99mTcN-NOET GSPECT MPI can be used for diagnosis of myocardial ischemia in hypertension in patients with diabetes mellitus the hypertension. Part 2 Relevant Factors Analysis of Influencing Lung Uptake in 99mTcN-NOET GSPECT Myocardial Perfusion ImagingObjective:Finding out the relevant factors of heart lungs ratio (LHR) in 99mTcN-NOET Gated SPECT myocardial perfusion imaging using related factors for multiple linear regression analysis.Methods:Retrospected 172 cases who had be suspicious and (or) patients with coronary heart disease diagnosis and made 99mTcN-NOET Gated SPECT exercise-delay gating myocardial perfusion imaging from 2005 to 2010,have male 112 cases and female 60 patients, the age range from 25 to 75 years, average age 50.81±11.20 (age). Using epidemiological analysis method of the index, which established screening measurement and multivariate linear regression model of lung uptake. The index is:gender, age, angina pectoris, whether the electrocardiogram abnormalities, sports or chest frowsty, sports level, whether of times, lipid level, smoking, alcohol, hypertension, whether diabetes, the exercise of EDV、ESV and EF, and delayed EDV、ESV and EF, andΔEF、TID, exercise L/S, delay L/S.Results:①Stress LHR with the smoking 1 (βi= 0.115, t= 3.198, P< 0.05), smoke 2 (βi= 0.175, t= 5.565, P< 0.05), Stress L/S(βi= 0.081,t= 2.582, P< 0.05), the movement of chest pain (βi= 0.081, t=2.582, P< 0.05), and blood pressure 2 classification (βi=-0.082, t=-1.98, P< 0.05).②Delay LHR with smoke 2 (βi=0.153, t= 4.962, P< 0.05), delay score (βi= 0.022, t= 2.609, P < 0.05), the movement of chest pain (βi= 0.073, t= 2.249, P< 0.05).Conclusions:②Exercise LHR is significantly associated with subjects smoking, Stress L/S, the movement of chest pain,blood pressure classification indexes.②Delay LHR is significantly associated with subjects smoking, delay scores in sports and of chest pain index. Part 3 Clinical Utility of Attenuation Correction with X-rays in 99mTcN-NOET Myocardial Perfusion SPECT StudiesObjective:Attenuation artifacts adversely affect the diagnostic accuracy of myocardial perfusion imaging. We assessed the clinical usefulness of X-ray CT based attenuation correction (AC) in patients performed 99mTcN-NOET myocardial perfusion imaging by comparing their myocardial AC-and non-corrected (NC) SPECT images.Methods:We retrospectively reviewed the 99mTcN-NOET myocardial SPECT images of 54 patients (38 men,16women; mean age 51.69±11.38 years). They underwent sequential CT and myocardial SPECT imaging with 99mTcN-NOET (111 MBq) under an exercise-delay protocol using our combined SPECT/CT system. Two reading sessions were held. First, non-corrected (NC)-SPECT and second, AC-SPECT images using X-ray CT images were interpreted. Interobserver variability was assessed with kappa statistics. Diagnostic performance (accuracy) of coronary arterial stenosis was compared between AC-and NC-images. At same time,we also obervered 20 and 5 section radioactive percentage and scores by the computer automatically dealing. Comparison of sex differences in X-ray CT using 99mTcN-NOET myocardial perfusion imaging. P< 0.05 was considered statistically significant.Results:①Image analysis:X-ray attenuation of myocardial perfusion imaging,obviously improve the quality of images, especially for the inferior wall, liver and myocardial down too close, overlap of radioiodine for imaging agents excessive.②20 MPI section analysis: radioactive distribution percentage in 15 segments are statistically significant (P＜0.05), except basal parts of the anterior wall, apex, anterior wall AC distribution percentage is reduced after radioactivity, differ significantly (P<0.05), inferior wall, close inferior wall and the percentage increase radioactive distribution intervals, different significantly (P<0.05). Score in six section statistically significant (P< 0.05), in cardiac apex and anterior wall, score increased significantly (P< 0.05), inferior wall, rating decreased significantly (P< 0.05). The cumulative score corresponding segment, the cumulative score can increase cardiac apex (9,13), the cumulative score inferior wall (15、16、16、11、7; 2、0、3、3、6).③5 segments MPI bull’s-eye:the analysis of apex and anterior wall of radioactive distribution percentage reduction, AC on apex wall and inferior wall of the distribution of radioactive is to reduce, but apex is obvious (P＜0.001), Lateral wall, inferior and the segtal of AC, and inferior wall and segmental statistically significant (P<0.001).④The bull’s-eye map section 20:men are statistically significant heart with the overall sarcomere myocardial differences, basic similar segmental wall and close down inferior distribution under the wall, every other scattered wall, For women, the difference of the two major heart sarcomere distribution, the first key areas for inferior wall, another distribution in cardiac apex and the anternionwall area near the cardiac apex, The bull’s-eye map section 5 percentage distribution in general, radioactive, male and female group, the difference between the total in cardiac apex, but female group was not statistically different area, and 20 section for the classification of the sarcomere heart has no obvious difference.⑤Kappa value:the image of NC when Kappa value of interpretation 0.29, and joint AC image, Kappa value for 0.62, obviously improve the consistency heighten, and, after reading statistically significant, this means that the joint of the AC and NC image can increase diagnostic accuracy of medical image.Conclusions:①ray attenuation correction, can improve myocardial perfusion imaging 99mTcN-NOET image quality;②X ray attenuation correction, can obviously improve the myocardial perfusion imaging diagnosis accuracy;③X ray attenuation correction effective myocardial perfusion image inferior wall of artifact, cardiac apex and the anterior wall have new artifact;④myocardial after liver shadow near the wall, AC after the excessive correction and under the shadow of the liver;⑤the attenuation of the section of myocardial radioactive distribution difference and score a percentage of the differences in a wide range of radioactive distribution for the relative magnitude, rating score should be higher accuracy;⑥X ray attenuation of male 99mTcN-NOET SPECT myocardial perfusion imaging have a big influence of women.更多还原