The Application Of Radionuclide Myocardial Imaging In The Diagnosis Of Coronary Heart Disease And Chronic Total Occlusive Coronary Artery Disease

Part ⅠRadio-nuclear Imaging Study on Coronary Collateral Circulation and Myocardial Viability in Patients with Chronic Total Occlusion of Left Anterior Descending arteryObjective.To assess the effect of coronary collateral circulation(CCC)on myocardial viability in patients with chronic total occlusion of left anterior descending(LAD)artery.Methods.A total of 101 consecutive patients with confirmed diagnosis of total LAD occlusion in our hospital were enrolled.Rest 99mTc-MIBI SPECT myocardial perfusion and 18F-FDG PET were performed,in addition all patients received coronary angiography(CAG)at 3 months front and back.Both images were reconstructed in the same machine and QPS software was used to obtain the summed rest score(SRS),abnormal resting total perfusion defect(TPD),viable and non-viable myocardium,LVEDV,LVESV and LVEF in relevant patients.Based on CAG result,the patients were divided into 2 groups:CCC group,n=39 and No CCC group,n=62;according to existing old myocardial infraction and location of LAD occlusion,the patients were further into 4 subgroups.The above parameters were compared among different groups.Results.There were 86 male and 15 female patients with the mean age at(59.9 ± 11.4)years.Relevant parameters in CCC group and No CCC group were as in SRS:(21.2 ±9.7)vs.(28.6±8.8),TPD:(30.0±13.7)%vs.(40.4±12.5)%,viable myocardium:(21.8±13.1)%vs.(13.7±9.2)%,non-viable myocardium(8.3±8.6)%vs.(27.4±13.0)%,all P<0.05;in LVEDV:(109.8±30.0)ml vs.(173.7±57.7)ml,LVESV:(62.8±22.4)ml vs.(122.5±51.7)ml;LVEF:(43.9±8.5)%vs.(31.0±8.3)%:all p<0.05.Conclusions.Our preliminary study found that CCC could maintain left ventricular rest perfusion,myocardial viability and protect cardiac function in patients with chronic total LAD occlusion.Part ⅡThe value of SPECT/CT myocardial perfusion imaging,CT attention correction and coronary artery calcium score one-stop examination for detecting myocardial ischemiaObjective.To evaluate the differences between the myocardial perfusion imaging(MPI)and CT attenuation correction(CTAC)MPI in image quality and diagnosis of myocardial ischemia.To further evaluate the value of MPI,CTAC andcoronary artery calcium score(CACS)and combination of the three techniques one-stop examination for detecting myocardial ischemia.Methods.One hundred and forty-eight patients who underwent invasive coronary angiography referred for SPECT/CT myocardial perfusion imaging were prospectively studies.According to the presence of CTAC,the patients were divided into CTAC MPI and no attenuation correction(NO AC)MPI in the two groups,and to analysis both in the left ventricular wall section of the radioactive count percentage[sex,body mass index(BMI)],image quality,the difference between myocardial perfusion and left ventricular cardiac function parameters.According to coronary angiography,the coronary artery stenosis(value≥70%)as a criteria,investigating the diagnostic efficacy of CTAC MPI and NO AC MPI.Of the 54 patients with SPECT/CT MPI and CACS one-stop examination,used to evaluate the receiver-operating characteristic(ROC)curve CACS,NO AC MPI,CTAC MPI and combined to the diagnosis of myocardial ischemia.Results.(1)The radioactive count of CTAC images in the left ventricular inferior wall,septum significantly higher than NO AC images(p<0.001),and in the apex,anterior wall significantly lower than NO AC(p<0.05),the lateral wall was no significant statistical difference(p>0.05);(2)The male patients radioactive count of CTAC and NO AC images in the left ventricular inferior wall and lateral wall significantly lower than female patients(p<0.05);(3)The radioactive count of CTAC and NO AC images with normal BMI in the left ventricular inferior walll、septum and lateral wall significantly lower than high patients(p<0.05);(4)The SRS、SDS、s-TPD obtained from the CTAC MPI were higher than NO AC MPI(p<0.05),and SSS、r-TPD were significantly lower than NO AC MPI(P<0.001);(5)Mean image quality score for CTAC MPI(3.6±0.5)was superior to NO AC MPI(3.1±0.4,p<0.05);(6)CTAC MPI showed high diagnostic concordance with NO AC MPI.The area under the ROC curve(AUC)were 0.66、0.67 for CTAC MPI、NO AC MPI(p>0.05);(7)Of 54 cases,the area under AUC were 0.71、0.75、0.67、0.73 for CACS、CACS in combination with NO AC MPI、CACS in combination with CTAC MPI、CACS in combination with NO AC MPI and CTAC MPI,respectively.109.6 was the optimal cut-off,and as the positive standard.Conclusion.(1)CTAC MPI will affect the radioactive distribution of the left ventricular,and the image quality was superior to NO AC MPI.(2)CTAC MPI showed high diagnostic concordance with NO AC MPI;(3)CACS and MPI on the diagnosis of myocardial ischemia had a certain value.The detection ability can be improved by combination of the functional-anatomic techniques.