Intravenous Dipyridamole Technetium-99m Mmi Myocardial Perfusion Scintigraphy for Detection of Coronary Artery Disease

以靜脈注射Dipyridamole做壓力相Tc-99m MMI 心肌灌注造影偵測冠狀動脈疾病

楊朝欽(Chao-Chin Yang) ； 吳重慶(Chung-Chieng Wu) ； 鍾相彬(Shiang-Bin Jong) ； 沈立漢(Lie-Hang Shen) ； 魏孝萍(Shiaw-Pyng Wey) ； 丁幹(Gann Ting)

《The Kaohsiung Journal of Medical Sciences》 8卷2期 (1992/02) Pp. 59-74

https://doi.org/10.6452/KJMS.199202.0059

摘要

為了評估靜脈注射dipyridamole做壓力相Tc-99m MMI心肌灌注造影對偵測冠狀動脈疾病(CAD)的功效，從1990年9月至1991年10月，我們對66例CAD或疑CAD患者，做Tc-99m MMI平面同位素造影與單光子射出性電腦斷層掃瞄，以為分析。此66病例分為二組：第1組44例，均接受冠狀動脈攝影術，但以前未曾接受冠狀動脈氣球擴張術或血管繞手術治療；第2組22例，雖沒有接受冠狀動脈攝影術，但有明顯的陳舊性心肌梗塞之病史和心電圖變化。影像資料的收集，包括壓力相(dipyridamole靜脈注射後1小時)與休息相(約24小時後)。分析結果顯示：第1組中，冠狀動脈攝影術和Tc-99m MMI心肌灌注造影均為異常的有35例(79.5％)，均為正常的有7例(16％)，另有2例(4.5％)，前者結果異常，後者卻正常。而在同為異常的35例中，21例(60％)之2種檢查方法顯示完全相同的冠狀動脈異常，其中包括13例為一條冠動脈疾病，5例為二條冠狀動脈疾病和3例為三條冠狀動脈疾病。第2組除一例外所有病例的Tc-99m MMI心肌灌注造影均為異常；且其中12例(55％)之CAD範圍較心電圖之診斷呈現更多的冠狀動脈異常。若以冠狀動脈疾病的靈敏度在左前下降枝，左迴旋枝和右冠狀動脈分別為96％，45％和89％而特異度分別為94％，100％和88％。在第2組的靈敏度為95％。合併計算，則靈敏度為95％。因此，我們認為靜脈注射dipyridamole Tc-99m MMI 壓力相與休息相造影，在偵測CAD上，應為一具相當價值的非侵襲性檢查方法。

並列摘要

To evaluate the efficacy of stress technetium-99m MMI (N-2-methoxy-2-methyl propyl isonitrile) myocardial perfusion scintigraphy (Tc-99m MMI) using intravenous dipyridamole for detection of coronary artery disease (CAD), we collected 66 cases (53men, 12 women, aged 40-79 years old) between Sept. 1990 and Oct. 1991. The cases were divided into two groups: group I involving 44 patients received coronary arteriography (CAG) examination without previous percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass graft (CABG); group Ⅱ embracing 22 patients received no CAG examination but all were suffering from old myocardial infarction (MI) evidenced by history and electrocardiography (ECG). All cases underwent Tc-99m MMI and CAG, 35 (79.5%) were positive and 7 (16%) were negative by both tests and another 2 (4.5%) were positive by CAG only. Of those positive by both tests, 21 (60%) suffered from identical coronary arterial involvement, including 13 one-vessel disease, 5 double-bessel disease and 3 triple-vessel disease. Of group Ⅱ patients, 14 suffered from old inferior wall (IW) MI, 6 from old anterior or anteroseptal wall (AW) MI, 1 from old lateral wall (LW) MI and another 1 from combined old anterior and lateral wall (ALW) MI by ECG. Of the 14 patients with IWMI by ECG, all suffered from right coronary artery (RCA) disease but 7 (50%) of them from multivessel disease (MVD) by Tc-99m MMI. 5 of the 6 patients with AWMI by ECG suffered from left anterior descending coronary artery (LAD) disease, but 3 of them from MVD by Tc-99m MMI. Both patients with LWMI and ALWMI by ECG suffered from triple-vessel disease by Tc-99m MMI.
The sensitivity of Tc-99m MMI in detecting CAD in group I was 95%, the specificity was 100%. The sensitivity for detection of individual coronary artery disease in LAD, left circumflex coronary artery (LCX) and RCA was 96%, 45% and 89% in this order and the respective specificity was 94%, 100% and 88%. In group Ⅱ the sensitivity was 95%. The overall sensitivity of intravenous specificity was 100% and accuracy aws 95%.
In conclusion, stress Tc-99m MMI using intravenous dipyridamole is a valuable method for evaluation and detection of CAD.

並列關鍵字

Tc-99m MMI ； single photon emission computed tomography