NGHIEN c t r u DOI CHIEU XA HINH TlTdl MAU CO TIM THEO PHirONG PHAP GATED SPECT V d l KET QUA CHJJP
DQNG MACH VANH TREN 131 B $ N H NHAN LE NGOC HA, LE MANH HA, BUI QUANG BifiU
Khog r hgc hgt nhdn - Benh vien TlfQD 108
Summary: The objective of our study was to correlate myocardial perfusion imaging (MP!) to coronary artery angiograms.
Subjects and Methods: 131 suspected coronary artery disease (CAD) and known CAD patients underwent Tc99m-MIBI SPECT MPI with exercise or dipyridamole stress in Nuclear Medicine Department, 108 Central Military Hospital. The MPI results were correlated to coronary angiograms.
Results: in CAD diagnosis, sensitivity and specificity of gated SPECT MPI were 97.5%
and 73.3%, respectively. For multivessel CAD, senshivity was 71.1% and specificity was 85.3% compared to 94.7% and 60% in singlevcssel CAD. Exercise gated SPECT MPI were more accurate than ECG exercise test in CAD diagnosis. No significant differences of diagnostic sensitivity, specificity and accuracy were observed when the patients were divided into exercise stress or dipyridamole stress; male or female, under or over 60 year olds groups.
Conclusions: gated SPECT MPI with exercise or dipyridamole stress was accurate tool in CAD diagnosis..
I. DAT V A N DE
B?nh dong mach vanh (DMV) hay la mpt trong nhung nguyin nhan gay tai biln va tu vong hang dau d cac nude phat trien ciing nhu d Vilt Nam. Trong nhiing nam gSn day, cdc dng dung cua y hpc hat nhan da cd nhung tien bo vupt b^c va dupe su dyng rpng rai trong linh vuc tim mach, trd thanh chuyen nganh tim mach hat nhan (Nuclear Cardiology) va chiim tdi 20 - 30% tdng s6 lupng xet nghiem y hpc hat nhan. S6 lupng thSm dd tim mach hat nhan, chu yeu la xa hinh tudi mau co tim d Hoa Ky tang tu 2,9 tri^u lugt b?nh nhdn (BN) trong nam 1994 tang len 5,8 trieu vao nam 1999 va dat khoang 10 trieu ISn xet nghiem vao nhung nam gan day. Xa hinh tudi mau ca tim (Myocardial Perfusion Imaging - MPI) la phuang phdp chan doan khong chay mau cd gia tri chSn doan benh DMV. Cac nghien cdu da thSy phuang phap nay cd dp nhay khoang 80 - 90% va dp dac hieu 70 - 80%, cao hem ro rit so vdi dien tim gjng sue (DTGS) trong chin doan benh DMV. Ngay nay, ben canh viec ddnh gia tinh trang tudi mau co tim, viec dua vao su dung ky thuat chup SPECT gSn cdng dien tim (gated SPECT) cdn cho phep danh gia van dpng thanh that, kfch thudc va chuc nang that trdi. Cdng vdi ung dung cua gated SPECT, nhttng tiin bp ve phSn cdng va phin mIm cua cdc thi he may gamma camera SPECT mdi ra ddi da cho phep ngudi dpc kit qua cd thi phan bi|t nhieu tap (artifact) vdi cdc tin thuong khuyit xa b$nh ly. Nhttng tiin bp nay da cai thien ddng ki dp dac hieu, giam ty le duong tfnh gia trong chin dodn benh.
Tai Viet Nam, do nhttng dieu kien thiiu thin td nhimg nam truac vi trang thiit bj, nguin dupe chit phong xa, nhan luc dupe dao tao cdn han chi ... din tdi vice triin khai ky thuat MPI cdn khd khaii. Mpt s6 nghien cuu vi MPI nhttng nam gin day d Benh vien TUQD 108, Benh vien Cho Ray, Benh vi?n Viet - Phdp tai thanh phi H6 Chi Minh chu yiu di cap din viec triin khai va kit qua nghien ciiu budc diu vi ling dung MPI. Nghien cdu nay cua chdng toi dupe tien hanh vdi s6 lupng Idn BN chup MPI bang phuang phap gated SPECT nhim muc tieu xdc dinh gid tri cua phuang phap xa hinh gated SPECT tudi mdu co tim Tc99m-sestamibi trong chan doan benh dpng mach vanh.
Hdi nghf Khoa hgc vd Cdng ngh? hgt nhdn todn qudc Idn thir IX, Ninh Thudn 18-19/8/2011 529
II. DOI Tl/ONG VA PHU'ONG PHAP NGHIEN CUtJ 1. Doi tugng nghien ciru
131 benh nhan (BN) nghi ngo hoac da dugc chSn doan benh DMV duoc gui dhn kham va chyp MPI tai khoa Y hgc hat nhan, Benh vien TUQD 108 trong thoi gian tir 6/2007 - 6/2009.
• Tieu chuan chpn benh nhan
- Benh nhan nghi ngo ho^c da dugc chan doan benh DMV dugc dieu tri va theo doi ngi - ngo?i tni tai B?nh vien TU"QD 108 co chi dinh chup MPI vol Tc^^*" - MIBI theo chi djnh cua Hgi tim mach hgt nhan Hoa Ky.
- B$nh nhan co day du ho so, dugc tham kham lam sang kj? luong va cac xet nghiem tham dd can thiSt nhu di$n tim, sieu Sm tim,....
- B?nh nhan dong y tham gia vao nghien ciiu.
• Tieu chuan loai trir
- B?nh nhan co chong chi dinh cua gang sue the luc hoac gSng siic sir dung thu6c (theo hir6ng dan thuc hanh ciia H6i tim mach hat nhan Hoa Ky nam 2003).
- B?nh nhan khong co day dii cac xet nghiem, tham do kem theo.
- Benh nhan khong tuan thu diing quy trinh ging siic.
- Benh nhSn c6 hinh anh MPI nhilu, x4u khong cho phep phan tich kht qua.
2. PhuoTig phap nghi€n ciiii
- Thi^t kh nghien ciru; phan tich ti§n ciiu.
- Cac buoc tien hanh:
+ Kham ldm sang va cac xet nghiem: cac benh nhan nghien ciiu dugc kham lam sang ti mi, danh gia yeu to nguy co, co day du cac xet nghiem ckn thilt (sinh boa mau, dien giai, X quang tim phoi, dien tim, sieu am tim), dang ky vao ho so nghien ciiu theo mau thong nhat.
+ Chup MPI Tc99m - MIBI theo phuomg phap gated SPECT pha nghi va pha gSng siic.
• Gang sire the luc su dung tham lan hoac gang siic bang thuoc (Dipyridamole, Dobutamine) theo huong ddn ciia Hgi tim mach hat nhan Hoa ky (ASNC) 2003.
• Tc^"" - MIBI lilu 15-20 mCi (0,31mCi/kg) tiem tinh mach.
• Phuong tien: May SPECT Gamma camera Millenium cua hang GE (Hoa Ky), Nucline Spirit cua hang Mediso (Hungari) va phhn mIm xii ly hinh anh kem theo.
+ Quy trinh thu nhan anh: Thu nhan hinh anh SPECT dugc thuc hien voi collimator song song, nang lugng thap, do phan giai cao, thu nhan 6 32 vi tri theo quy dao 180° , 25 giay/1 anh, 8 anh mgt chu ky neu co gan cong dien tim (gated SPECT), ma tran 64 x 64. Hinh anh dugc xii ly bang phan mem cho cac lop cit theo true short axis, vertical long axis va horizontal long axis.
+ Danh gia ket qua: Hinh anh xa hinh tuoi mau ca tim dugc phan tich boi 2 bac sT y hgc hat nhan khong dugc biet ket qua dien tim ging siic va chup DMV. Ket qua phan tich theo hudng din thuc hanh tim mach hat nhan cua ASNC (2003).
+ Chup dgng mach vanh: Thuc hien bang may chup mach Integis Alura Biplance ciia hang Philips. Sir dung ong thong Judkins, chup lan lugt cac nhanh chinh DMV tren nliilu
530 Hdi nghi Khoa hgc vd Cdng nghi hgt nhdn todn qudc idn thur IX, Ninh Thudn 18-19/8/2011 binh dien, cac ket qua dugc phan tich boi bac sy tim mach co kinh nghiem. Hinh anh t6n thuang dugc xac dinh khi mite dp hep > 50% va > 70% duang kinh cac than d6ng miich chinh (dpng mach lien that truoc, dpng mach mu, DMV phai).
3. Xu ly so lieu
So lieu nghien ciiu dugc xir ly theo cac thuat toan thong ke y bgc b3ng chuong trinh SPSS 18.0
III. KET QUA NGHIEN CUU
Bdng 1. Mot sd dgc diim ldm sdng chung cua benh nhdn nghiin cuu Cdc ddc diem lam sdng
Tudi Gidi Dau nguc
Trung binh (X ± SD)
<60
>60 Nam NO Dien hinh Khong dien hinh Khdng trieu chung Tang huyet ap Tang lipid mau Dai thdo dudng Hut thudc Beo phi (BMI > 25)
NMCT cu Suy tim
si luang (n= 131) \ Ty 1$ % 65,8 ±11,7 83
130 191 22 85 97 31 141 89 50 24 63 115 23
38,9 61,1 89,9 10,3 39,9 45,5 14,6 66,2 41,8 23,5 11,3 29,6 53,9 10,7
Da so BN la nam gioi (89,9%), nhom tuoi > 60 chiem ty le 61,1%, BN thuang co cac yeu to nguy CO nhu tang huyet ap, roi loan lipid mau. Ty le BN c6 NMCT cu kha cao (53,9%).
Doi chieu voi ton thuang hep > 70% duang kinh tren ket qua chup dpng mach vanh, phuong phap gated SPECT xa hinh tuoi mau co tim co do nhay 97,5%, do dac hieu 73,3% , gia tri du bao duong tinh (PPV) 93,5%, gia tri du bao am tinh (NPV) la 83,3% va dp chinh xac (Ace) 92,2% trong chan doan benh dgng mach vanh. Trong so cac nhanh dgng mach vanh, dpng mach vanh phai co do nhay cao nhdt 79,7% nhung do nhay thip 57,1%. Dpng mach mu co dp nhay chSn doan thap nhung dp dac hieu cao nhit (94,7%).
Khong CO sir khac biet ro ret vh dp nhay cua MPI trong chin doan benh miic dp hep >
50% va > 70% dgng mach vanh (96,5% va 97,5%). Dp dac hieu chan doan vai miic hep >
50% va 70% la 74,2 % va 73,3 %.
U0i „2hi Khoa hgc vd Cdng nghi hgt nhdn todn qudc lan thu IX, Ninh Thudn 18-19/8/2011 531
Sen Spe PPV NPV Ace
Chung* « OM lien that trUdc • OM mu • OM vanh phai
* Cdc gid trj chdn dodn chung cita MPI v&i mux: do h?p > 70% ddng mgch vanh, khdng tinh den sir chdn dodn chinh xdc cua timg nhanh dgng mgch vanh
Bieu dd I. Gid tri chdn dodn gated SPECT xg hinh tudi mdu ca tim
60
40
I
I Hep > 50%<. Hep > 70%
Sen S p e PPV NPV Ace
Bieu dd 2. So sdnh gid Iri chdn dodn cua MPI vdi 2 mic hep DMV > 50% vd > 70%
:ffiSiS5
Biiu di 3. So sdnh duang cong ROC ciia dien tim ging sic the luc vd SPECT MP!
Phuang phap SPECT MPI cd dp nhay va dp dac hieu eao ban so vdi dien tim gang sue the lire trong chan doan benh DMV (p < 0,01).
532 Hdi nghi Khoa hgc vd Cdng ngh? hgt nhdn todn qudc idn thu IX. Ninh Thudn 18-19/8/2011
Sen Spe PPV NPV Ace
• SPECT MPI g I n g siic the ii/c • SPECT MPI gang siic vdi Dipyridamole
Biiu do 4. So sdnh gid tri chdn dodn gated SPECT MPI giira 2 phuang phdp gang sire the lire vd su dyng dipyridamole
Do nhay, dp dac hieu va do chinh xac ciia chup MPI theo phuong phap gang siic the luc la 96,9%, 74,2% va 86,7% khac biet khong ro ret so voi cac gia tri tuong iing 6 nhom sir dung dipyridamole lin luot la 97.6%. 66.5% va 86.7%.
Sen Spe PPV NPV Ace
• Benh da mach " Mpt mach
Bieu do 5. Gid tri chdn dodn ciia MPI trong chdn dodn binh da mgch vanh Trong chan doan benh da mach vanh, MPI co dp nhay 71,1% (thip han so voi t6n thuong 1 mach la 94,7%) va dp dac hieu 85,3% (cao han so voi chin doan t6n thuong 1 mach la 60%).
Ace BQSH^Q NPV I^SI^^S PPV ^ ^ B B B Spe ^ ^ B 2 B Sen ^ ^ ^ g i j ^ g
a.i
al.5 • Nd
• Nam
Bleu do 6. So sdnh gid tri chdn dodn cua gated SPECT MPI a nhdm nam va ni
fioi nghi Khoa hgc vd Cdng nghe hgt nhdn todn qudc Idn thu DC, Ninh Thudn 18-19/8/2011 533
Khong CO su khac biet ro ret ve do nhay va dac hieu chan doan cua MPI o nhom BN nam va nii.
i > 6 0
• < 6 0
Biiu do 7. So sdnh gid tri chdn dodn cua gated SPECT MPI theo nhdm tudi Khong CO su khac biet ro ret ve dp nhay chan doan ciia MPI 6 2 nhom BN > 60 va <
60 tu6i. Dp dac bi$u chin doan co xu huong cao hon khong ro ret 6f nh6m BN > 60 tu6i.
IV. BAN LUAN
Khi doi chieu vol k6i qua chup dpng mach vanh v6i ton thuong hep > 70% duong kfnb, nghidn cuu ciia chiing t6i cho tha'y phuang phap gated SPECT xa hinh tuoi mau ca tim co do nhay 97,5%, do dac hieu 73,3%, gia tri du bao ducmg tinh 93,5%, gia tn du bao am tinh la 83,3% va dp chinh xac 92,2% trong chan doan benh dgng mach vanh. Trong chan doan benh da mach vanh, MPI co do nhay 71,1% (thap hon so voi ton thuong 1 mach la 94,7%) va dp dac hieu 85,3% (so voi chan doan ton thucmg 1 mach la 60%). Nghi6n cuu ciia Huynh Kim Phircfng tai Benh vidn Chg Ray cho tha'y da nhay ch^n doan la 99,7% cao hon so vdi nghien cihi cua chiing tPi nhung d6 dac hieu ciia tac gia chi dat 61,5% tha'p hon dp dac hieu trong nghien cuu ciia chung t6i. Ke't qua t6ng hgp 33 nghien ciiu ciia Klocke KJ cho thay do nhay la 87%, do dac hieu 73% ciia MPI trong ch^n doan hep > 50 % ducmg kinh dpng mach vanh. Dp nhay va dp dac hieu ciia MPI phu thu6c vao nhieu ye'u to nhu ton thuong mot mach hay da mach, dugc cha't phong xa sii dung (Tl-20i bay Tc99m-sestamibi, Tc99m-tetrofosmin), phucmg phap chup (planar hay SPECT), phuong phap phan tich dinh tinh hay dinh luong, danh gia tudi mau co tim dcm thu^n hay ke't hgp vdri phan tich van dpng thanh va chiic nang that trai bang phuong phap chup SPECT MPI gin c6ng dien tim, phuong phap gang siic th^ luc hay sir dung thudc ... Ngoai ra, vi dd nhay va dd dac hieu ciia MPI dugc tfnh toan dua vao "tieu chu^n vang" la kei qua chup DMV, do dd, gia tri nay phu thugc vao ngudng (cut-off) tieu chu^n danh gia hep DMV co y nghia (hep tren 50% hay tren 70% dudng kinh DMV). Slomka, so sanh ke't qua dp nhay va do dac bieu cua MPI vdi 2 miic ngudng khac nhau ve mirc do hep cd y nghTa DMV, nhan Iha'y dp nhay va dd dac hieu ciia MPI la 84% va 74% dd'i vdi miic hep
>50% dudng kinh DMV va 86% va 72% vdi t6n thuong hep >70% dudng kinh DMV. Khdng CO su khac bifit ro rdt v^ dp nhay cua MPI trong ch^n doan benh miic do hep > 50% va > 70%
dong mach vanh (96,5% va 97,4%). Dd dac hieu ch£n doan vdi miic hep > 50% va 70% la 74,2 % va 68 %. Nhi^u tac gia nhu Depuey, Ruiz, Hendel va cpng su cho rang cd kha nhieu yeu td anh hudng tdi hinh anh MPI va co the lam cho ke't qua ch^n doan sai Idcb hoac la duong tfnh gia hoac am tinh gia. Cac yeu td cd the anh hudng tao ke't qua duong tinh gia nhu:
DMV bai thudng, co that DMV, ciu ca tim, bloc nhanh trai hoan toan, cac nhidu tap (artifact) tii thanh nguc dl ly d phu nir, ngudi beo phi, do co hoanh trai d cao, hoac benh nhan bat dpng khdng tdt trong khi dang chup MPI. Cac yeu td cd the anh budng de'n su phan tfch ket qua am
534 Hdi nghj Khoa hgc vd Cdng nghe hgt nhdn todn qudc idn thir IX, Ninh Thudn 18-19/8/2011 ti'nb gia bao gdm; benh nhan gang siic dudi mtic tdi da du tinh theo tu6i, vung thi^u mau co tim hep, tu^n hoan bang he sau chd hep tdt hay trong trudng hc^ bdnh t6n thuong da DMV....
Trong so cac nhanh dgng mach vanh, k^t qua nghidn cihi cua chiing tdi cho thSiy dpng mach vanh phai cd do nhay cao nhat 79,7% nhung dd nhay thap 57,1%. Dpng mach mu c6 dp nhay chan doan thap nhimg dp dac bieu cao nhat (94,7%). Nghidn cuu cua Dao Tid'n Manh da tb^iy dd nhay, dd dac hieu, dp chinh xac du bao cua MPI ddi vdi vung chi phdi ciia Udn th^t trude g^n 80%, dd nhay ddi vdi ddng mach mu tha'p (40%), dd dac hidu ddi vdi nbdnh DMV phai la thap nbai (57,7%). Theo M ^ , phuong phap MPI cd dd nhay cao tuong duong trong ch^n doan t6n thuang ddng mach lidn tha't trude va DMV phai, trai lai, nhanh DM mu cd dd nhay tha^p hon, cd le do hSu bet cac bdnh nhan cd ki^u phSn bd DMV phai trdi, nhanh mu chi chi phdi mdt viing nhd co tim ndn t6n thuong thudng dd bi bd qua. Vide phan chia viing chi phdi ciia tiing than DMV cho cac viing co tim chi mang tinh ch^t tucmg dd'i, cd tb^ cd nhihig viing CO tim dugc nudi dudng bdi ddng thdi nhi^u nhanh mach, ngugc lai 1 nhanh DMV cd the chi phdi cho nhidu vCing co tim khac nhau dac bidt trong cac trudng hgp tinh trdi cua DMV khac nhau hoac giai phiu DMV bS^t thudng. Ngoai ra, cdn cd su tham gia cua tinh trang tuSn hoan bang bd tham gia vao viec cung cap mau cho vting co tim ma nb^nh DMV chiu trach nbidm chinh bi t6n thucmg.
Khi so sanh nhdm BN gang su:c 2 nhom BN chup MPI bang gIng siic th^ luc vk sii dung dipyridamole, chung tdi da tha'y dp nhay, do d^c hieu va dp chinh xac cua chyp MPI theo phuong phap gang siic the luc la 96,9%, 74,2% va 86,7% khac biet khdng rd rdt so voi cac gia tri tuang iing d nhdm sii dung dipyridamole lan lugt la 97,6%, 66,5% va 86,7%. Cac kdi qua nghidn cihi ciia chiing tdi cung phii hop vdi nhan dinh cua nhi^u nghidn ciiu da cho rang ca bai phuong phap chup MPI d^u cd gia tri tuong tu. Klocke FJ vh cs cho th^y dd nhay va dac bidu ciia MPI ging siic bang thudc \k 86% vh 73%. Berman DS, Kiat H va cs tha'y dd nhay ciia MPI sii dung dipyridamole va adenosine la 89 d^n 91%, dd dac bidu dat dugc tuong tu nhu khi ging siic th^ luc. Nghidn cihi cua Iskandrian AE va cs da tha'y ging su:c bing adenosine co do nhay cao ho^ trong phat hidn t6n thuong 1 mach d cdc bdnh nhan nii. Trong 2 nghien ciiu da trung tSm voi tong so 244 BN, dp nhay, do dac hieu va dp chinh xac ch^n doan benh DMV tuong img la 82%, 77% va 79% vdi MPI ging siic thd luc va 83%, 81% va 82%
vdi MPI gang siic bang adenosine. Trong mgt nghien ciiu da trung tam khac, MPI gang siic the luc va vdi adenosine dugc tien hanh d 175 BN trong vong 1 thang. Su phii hgp chan doan giOa gang sue the luc va vdi adenosine tuong ling la 83% va 86%.
So sanh su phii hgp chan doan giua ket qua di$n tim ging siic va xa hinh tudi mau co tim bang gang siic the luc, chiing tdi nhan tha'y su phii hgp quan sat gifla 2 phuong phdp la 63% va he s6 kappa la 0,26. Phan tich dudng cong ROC cho tha'j; phuang phap SPECT MPI cd dp nhay va dp dac bieu cao hon so vdi dien tim ging siic thd luc trong chin doan bdnh DMV (p < 0,01). Nghidn ciiu cua Huynh Kim Phugng va cs da th^y do nhay va dd dac bidu ciia NPGS trong chin doan thieu mau co tim la 30,4% va 65,2%. Tuong tu nhu nghidn cihi cua chiing tdi, nghien cuu ciia Dao Tid'n Manh cung tha'y phuong phdp xa hinh tudi mau co tim va nghiem phap gang siic trong chin doan doan cd su phii hgp quan sat la 68,5%, hd sd Kappa = 0,35 vdi p < 0,001. Fleischmann KE va cs so sanh sd lidu phan tich tit 27 nghidn cihi da tha^y MPI ging siic thd luc cd dp chinh xac cao hon rd ret so vdi didn tim ging siic. Nghien ciiu cua Christian va Hachamovitch sir dung hinh anh SPECT MPI tren 321 BN cd kha nang mic benh trung binh den cao truac xet nghiem va c6 dien tim nghi binh thudng, do chinh xac chin doan va gia tri du doan duong trong phat hien b?nh DMV hep tren 50%. dudmg kinh tuong ung la 79% va 91% ddi vdi SPECT MPI so vol 49% va 81% doi vdi dien tim ging siic (p<0,01).
SPECT MPI ging siic cd do chinh xac chin doan 75% a 30% s6 BN cd dien tim ging khong chan doan dugc do kha nang gang site dudi miic tdi da va co kha nang ldm han so vdi dien tim gang sire trong phat hien benh than chung DMV trai hoac benh ba mach n^ng .
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Nghien cihi ciia chiing toi cho th^y khong co su khac biet ro ret vi dp nhay va dac hieu ch5n doan cua MPI a nhom BN nam va nu (p <0,05). Mat s6 nghien cdu tren the gidri trude day Ihircfng sif dung T1-20I da thafy dp dac hieu khdng cao do hieu dng suy giam thucfng 6 thanh trude va trude ben 6 phu ntt. Phu nir thuang co benh dpng mach vatih 6 tu6i cao hon va khoang 40% khong the gang sire the luc nen phai tien hanh gang sue bang thu6c. Trong mpt s6 nghien cuu truoc day, chup MPI gang sue the lire co dp chinh xac cao bon a nam so vai nif gioi. Mpt s6 ylu t6 co the anh huong len dp chinh xac ciia MPI a phu nij bao g6m hieu ung suy giam do vu, khdi luong co tim va kich thuoc that trai nho hon. Dp nhay, dac hieu va gia tri du bao duang tinh cua MPI sir dung adenosine trong phat hien benh dpng mach vanh (dirimg kinh h?p >50%) a nil gidi la 93%, 78% va 88%. Ci nO gifJi co day thdt trai tren ECG, dp nhay va dp d^c hi6u trong phat hien benh dpng mach vanh la 94% va 67%. Tren 6173 benh nhan (43% la nO gioi) tiin hanh chup MPI bang adenosine, nam giai c6 ton thuong co hoi phyc khi nghi va gang sue Ion han nii gioi. Trong mpt nghien cuu khac, dp nhay cua MPI su dyng adenosine la 84% a benh nhan nir va 94% 6 nam giai (p <0,05). Khi chia BN thanh 2 nhdm dudi va tren 60 tu6i, chung t6i da thay khong co su khac biet ro ret ve dp nhay chan dodn cua MPI 6f 2 nhom BN > 60 va < 60 tuoi. Tuy nhien, dp dac hieu chan doan cao hon chua CO y nghia thong ke o nhom BN > 60 tuoi (p>0,05). Nhi^u tac gia cho rang gang sue bang adenosine hay dipyridamole an toan a cac benh nhan Ion tuoi. Dp nhay va dp dac hieu cua adenosine hay dipyridamole MPI voi sestamibi phat hien hep > 70% duong kinh dpng milch vanh 6 benh nhan >80 tu6i la 95% va 71%, phat hien hep > 50% la 86% va 75%.
V. KET LUAN
Phuong phap gated SPECT MPI c6 dp nhay 97,5%, dp dac hieu 73,3% trong chk doan benh DMV. Trong benh da mach, phuang phap gated SPECT MPI eo do nhay 71,1% thjp hon so vol t6n thuang 1 mach (94,7%) va dp dac hieu 85,3% so vai chan doan t5n thuang 1 m?ch (60%). Phuong phap gated SPECT MPI gang sue the lire co dp nhay va dp dac hieu cao hon so vai dien tim gjng sire trong chin doan benh DMV. Khong eo su khac biet ro rpt vi dp nhay, dp dac hieu va dp chinh xae eiia gated SPECT MPI thue hien bang gang siic the lire va gang sire bang dipyridamole, giira nam va nu, giua nhom BN > 60 va < 60 tuoi.
TAI LIgU THAM KHAO
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