目的：探讨静息态收缩期CT心肌灌注成像（CTP）诊断猪慢性心肌缺血的准确性及其与腺苷负荷动态CT灌注成像（ASDCTP）诊断心肌缺血能力的差异。方法：建立小型猪慢性心肌缺血模型，行13N-NH3 PET静息-腺苷负荷心肌灌注成像（MPI）获得静息态收缩期CTP及腺苷负荷动态 CTP。分别利用心肌透壁灌注比（TPR）和心肌节段血流量值（MBF）评估静息态收缩期CTP、腺苷负荷动态CTP各节段心肌缺血情况；以PET-MPI为金标准，评估静息态下收缩期CTP及腺苷负荷动态CTP诊断心肌缺血的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和准确性，并采用ROC曲线对两种检查的诊断价值进行比较。P<0.05为差异有显著统计学意义。结果：静息态收缩期CTP及腺苷负荷动态CTP诊断心肌损伤的准确性分别为75.89%和83.92%；敏感性、特异性、NPV和PPV分别为68.75%、81.25%、73.33%、77.61%和83.33%、84.37%、80.0%、87.1%。静息态收缩期CTP及腺苷负荷动态CTP的ROC曲线下面积（AUC）分别为0.75、0.84，P=0.07（P＞0.05）。结论：静息态下收缩期心肌灌注成像诊断猪慢性心肌缺血具有可行性。
Abstract
Objective: To determine the accuracy of the resting systolic myocardial perfusion imaging to assess myocardial ischemia with chronic coronary stenosis and the diagnostic differences capability of the dynamic adenosine-stress CT perfusion using a porcine animal. Methods: The chronic coronary stenosis models was build. 13N-NH3 PET adenosine stress-rest myocardial perfusion imaging(MPI) was obtained in order to have the resting systolic myocardial perfusion imaging(CTP) and the adenosine stress dynamic CT myocardial perfusion imaging(ASDCTP). The myocardial perfusion defect on the resting systolic CTP and ASDCTP were analyzed for the transmural differences in perfusion using the transmural perfusion ratio(TPR) and the myocardial blood flow(MBF) value, respectively. Taking PET-MPI as the reference standard, the sensitivity, specificity, positive predictive value(PPV), negative predictive value(NPV) and accuracy of CTP in the diagnosis of myocardial perfusion defect segments were evaluated. Using receiver operating characteristic curve(ROC) to assess the value analysis of the resting systolic CTP and ASDCTP. The threshold of significance was P＜0.05. Results: The accuracy of the resting systolic CTP and ASDCTP to detect perfusion abnormalities using PET-MPI as the gold standard were 75.89% and 83.92%; The sensitivity, specificity, PPV and NPV were 68.75%, 81.25%, 73.33%, 77.61% and 83.33%, 84.37%, 80.0%, 87.1%, respectively. The area under the receiver operating characteristic curve(AUC) of the resting systolic and the adenosine stress dynamic CTP were 0.75 and 0.84, respectively, P=0.07(P＞0.05). Conclusion: The resting systolic myocardial perfusion imaging to assess chronic myocardial ischemia using a porcine animal is feasible.
关键词
心肌缺血 /
体层摄影术 /
X线计算机
Key words
Myocardial ischemia /
Tomography, X-ray computed
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基金
国家自然科学基金（项目编号：81301221）；辽宁省教育厅高等学校创新团队（项目编号：LT201417）。
