心肌灌注的研究进展

作者:赵瑞平[1] 
单位:内蒙古包头市中心医院[1]
【关键词】 冠状动脉疾病;心肌灌注;冠脉造影
【Key words】 Coronary heart disease; Myocardium perfusion
   冠状动脉性心脏病(coronary heart disease)简称冠心病,是由于冠状动脉循环改变引起冠脉供血和心肌需求之间不平衡而导致的心肌损害,最主要的病因是冠状动脉粥样硬化
1 心肌灌注概述
   心肌灌注指流经心肌组织内冠状动脉血管网的血流,即从小动脉流入,经毛细血管到静脉流出的血流
2 心肌灌注的检查手段
2.1 正电子断层显像(PET)
   PET结合心肌灌注检测存活心肌,是检查存活心肌最有价值的无创性方法,被认为是检测存活心肌的“金标准”[1]
2.2 单光子断层显像(SPECT)
   最近,由于高能及符合线路SPECT的出现,使SPECT通过检测心肌代谢状态来评估存活心肌成为可能
2.3 心肌声学造影(MCE)
   心肌声学造影用于评估局部心肌灌注和节段室壁运动
2.4 磁共振心肌灌注
   磁共振对比剂首过心肌灌注法于1990年由Atkinson等首次应用,通过团注Gd-DTPA应用梯度回波反转恢复序列成像法,观察对比剂通过心腔和心肌的过程[6]
2.5 多排螺旋CT心肌灌注
   目前的多排螺旋CT(multidetector computed tomography,MDCT)时间分辨率和空间分辨率及探测器覆盖宽度都已经有很大的提高,能够满足在任意自然心率下的冠状动脉CTA检查
2.6 Flash双源CT心肌灌注
   双源CT拥有两套球管—探测器系统,能同时获得低能和高能两组图像,可以鉴别对比增强的结构和实质器官中的不同密度物质
   双能量CT可获得满意的冠状动脉影像,同时得到的心肌灌注成像也可满足临床诊断需要
3 心肌灌注的现状和展望
   心肌灌注成像虽然还未常规应用于临床,但随着心肌灌注检查手段的时间
4 参考文献
[1] Go RT, Marwick TH, MacIntyre WJ, et al. A prospective comparison of rubidium-82 PET and thallium-201 SPECT myocardial perfusion imaging utilizing a single dipyridamole stress in the diagnosis of coronary artery disease [see comments]. J Nucl Med,1990,31:1899-1905.
[2] Sampson UK, Limaye A, Dorbala S, et al. Diagnostic accuracy of rubidium-82 myocardial perfusion imaging with hybrid positron emission tomography/computed tomography (PET-CT) in the detection of coronary artery disease. J Am Coll Cardiol,2007,49:1052-1058.
[3] Omur O, Ozcan Z, Argon M, et al. A comparative evaluation of Tl-201 and Tc-99 m sestamibi myocardial perfusion spect imaging in diabetic patients. Int J Cardiac Imaging,2008,24:173-181.
[4] Burt RW, Perkins OW, Oppenheim BE, et al. Direct comparison of fluorine-18-FDG SPECT,fluorine-18-FDG PET and rest thall-ium-201 SPECT for detection of myocardial viability. J Nucl Med Feb,1995,36:176-179.
[5] NAGUEH S F,VADUGANATHAN P,ALI N,etal.Identificatim of hibernation myocardium: co-mparative accuracy of myocardial contrast echo cardiography, rest- redistribution thallium-201 tomogrsaphy and dobutamine echocardiography [J].J Am coll Cardiol,1997,29(5):985-993.
[6] Wu KC, Kim RJ, Bluemke DA, et al. Quantification and time course of microvascular obstruction by contrast-enhanced echocardiography and magnetic resonance imaging following acute myocardial infarction and reperfusion. J Am Coll Cardiol,1998;,32:1756-1764.
[7] Ingkanisorn WP, Kwong RY, Bohme NS, et al. Prognosis of negative adenosine stress magnetic resonance in patients presenting to an emergency department with chest pain. J Am Coll Cardiol,2006,47:1427-1432.
[8] Jahnke C, Nagel E, Gebker R, et al. Prognostic value of cardiac magnetic resonance stress tests: adenosine stress perfusion and dobutamine stress wall motion imaging. Circulation,2007;115:1769-1776
[9] George RT, Jerosch-Herold M, Silva C, et al. Quantification of myocardial perfusion using dynamic 64-detector computed tomography. Invest Radiol,2007,42:815-822.
[10] Ruzsics B, Lee H, Zwerner PL, et al. Dual-energy CT of the heart for diagnosing coronary artery stenosis and myocardial ischemia-initial experience. Eur Radiol,2008,18:2414-2424.
[11] 蒋学祥,邱建星,刘剑,等. 64层螺旋CT评估冠状动脉狭窄的准确性——与传统冠状动脉造影对照研究.中国医学影像技术,2006,22:1472-1476.
[12] Blankstein R, Shturman LD, Rogers IS, Rocha-Filho JR, Okada DR, Sarwar A et al. Adenosine-induced stress
myocardial perfusion imaging using dual-source cardiac computed tomography. J Am Coll Cardiol .2009,54:1072–1084
[13]毛新波,朱新进,陈涛,等.16层螺旋CT冠状动脉成像技术分析.中国心血管病研究。2005,3:600—602.
[14]谢培怡,许秀娟,姚宇玫,等.多层螺旋CT诊断急性冠脉综合征的临床价值.中国心血管病研究,2006,4:820—822.
[15]段慧,韩丹,徐燕.双源CT在左心室功能测定中的临床应用价值.中国心血管病研究,2008,6:574—577.

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2012/5/18 16:39:18
严国胜:很好,学习了。
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