The Study About MPI Intergrate CTA For Diagnosis Of Cad And The Value Of MPI In PTCA

Objective To evaluate the value of application fusion(13)~N-ammonia PET (positronemission tomography) adenosine stress/rest myocardial perfusion imaging(MPI) andcomputed tomography coronary angiography (CTA) in diagnosing the coronary arterydisease(CAD). Methods30patients who were suepected of having coronary arterydisease (females11and males19, mean age of33-71（55±14.5）years)were performed(13)~N-ammonia PET adenosine stress/rest MPI and coronary CTA in the AffiliatedHospital of Inner Mongolia Medical College from March2010to December2011.Andthey were performed coronary angiography(CAG) in one month. The results of MPIwere analyzed by qualitafion and half quantitative. Coronary CTA and CAG wereanalyzed by qualitafion. Treating CAG demonstrate>50%reduction of minimal lumendiameter as the"standard"to diagnosing CAD: comparing sensitivity, specificity,accuracy, positive and negative predictive values between CTA and CAG(13)~N-ammoniaPET adenosine stress/rest MPI and CAG,the fusion imaging and CAG by using SPSS17.0software.The data were performed with chi-square test or Fisher exact test. There isstatistical significance when P≤0.05. Result CAG data were defined reference standard:①CTA versus CAG: sensitivity,specificity,accuracy,positive and negative predictivevalues:90.0（36/40）,94.9%(279/294）,94.3%(315/334),70.6%(36/51) and98.6%(279/283).②(13)~N-ammonia PET adenosine stress/rest MPI versus CAG: sensiti-vity,specificity,accuracy,Positive and negative predictive values:85.7%(18/21),88.9%(8/9),86.7%(26/30),94.7%(18/19)and72.7%(8/11).③(13)~N-ammonia PET adenosine stress/rest MPI plus CTA versus CAG: sensitivity, specificity, accuracy, positive andnegative predictive values:95.2(20/21),100%(9/9),96.7%(29/30),100%(20/20) and90%(9/10).Conclusion Fusion of(13)~N-ammonia PET adenosine stress/rest MPI andcoronary CTA is a scientific method in diagnosis of CAD which can increase mutualsuperiority, avoid false positive and false negative from simple PET or CTA andimprove accuracy of CAD diagnosis. Objective To evaluate the value of clinical application of(99)~mTc-MIBI stress/rest gateMPI in coronary artery disease(CAD) patients before and after percutaneoustransluminal coronary angioplasty(PTCA）. Methods30CAD patients (females9andmales21, mean age of45-72（57±11.5）years) from the Affiliated Hospital of InnerMongolia Medical College were performed on PTCA interventional therapy fromJanuary2010to December2011.All the patients were performed coronaryangiography(CAG) and then they were performed PTCA or stent implantation when their coronary stenosis>70％.In addition,they were also performed(99)~mTc-MIBI gatestress/rest MPI2weeks before and3months after PTCA.①A semi—quantitativeanalysis using a20-segment and5-point scoring system was used by ECTOOLBOXprocessing software in both stress(SS) and rest(RS).The stress score(SSS) and restscore(SRS) were from the sum of20-segment radioactive fraction respectively.Whilethe difference of SSS and SRS was the myocardial ischemia difference(SDS=SSS-SRS),which was used for assessment of the degree of ischemia.It meansnormal,reversible ischemia and fixed ischemia when SSS=0, SDS≥3and SDS <3,SRS>1respectively.To analyze abnormal segment and score of MPI before andafter PTCA or stent implantation.②Using ECTOOLBOX to calculate left ventricularejection fraction(LVEF), end-diastolic volume (EDV), end-systolic volume(ESV) andthe number of segments of wall motion abnormalities before and after PTCA.SPSS17.0was used for data analysis． The data were performed with theindependent samples t-test or chi-square. Result①Among the320segmentscorrespond to44vessels of which coronary stenosis>70％,the abnormal segments ofRD were57.2%(183segments) before PTCA vs.2.2%(7segments) after PTCA.Theabnormal segments reduced significantly(χ~2=231.867, P<0.001).While the abnormalsegments of FD were18.4%(59segments) before PTCA vs.13.1%(42segments) afterPTCA.There was no significant differences(χ~2=3.398，P>0.05).The improvement rateof RD and FD were96．2％（176/183）and28.8％（17/59）respectively. The differencebetween that have statistical significance(χ~2=125.368，P<0.01).②The SSS and SRS ofRD before and3months after PTCA were3．21±0．513,1.58±0.324,1.32±O.573and0.68±O.276respectively. The SSS and SRS of FD before and3months after PTCAwere3.52±O.462,2.61±O.513,2.18±0.533and2.43±O.474respectively.The differencesof SSS and SRS in RD both have statistical significance(t=2.457，2.115，P<0．05).Andthe difference of SSS in FD have statistical significance(t=2.042，P<0．05) while thedifference of SRS in FD have no statistical significance(t=0.258，P>0.05).③Thevariation of parameters of left ventricular function and wall motion segments:the LVEF,EDV and ESV before and after PTCA were (52.3±16.1)%vs.(54.1±17.8)%,(101.4±48.5)%vs.(103.6±50.2)%and （50.2±32.5)%vs.（51.2±33.2）%respectively.The differences all have no statistical significance（t=0.075，0.032，0.022，P>0.05）. The number of segments of wall motion abnormalities before and afterPTCA were67.2%%（215segments）and60.0%(192segments) respectively. Thedifference have no statistical significance(χ~2=3.570, P>0.05). Conclusion(99)~mTc-MIBIstress/rest gate MPI has certain guiding significance in determining therapyprogram,case selection,risk stratification before PTCA and evaluate the curativeeffciency after PTCA.