| 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.
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