目的通过对心肌梗死患者行 双源CT首过及延迟增强双能量扫描，与 99mTc-MIBI心肌显像结果进行对比研究， 探讨双源CT首过及延迟心肌灌注成像在 识别及定位存活心肌的诊断价值。方法 28例心肌梗死患者接受双源首过及延迟 (5min)心肌灌注扫描及99mTc-MIBI心肌灌 注显影检查，观察双源CT心肌灌注碘图 评价心肌灌注缺损，将双源CT首过及延 迟扫描心肌灌注缺损与99mTc-MIBI的相应 节段进行对照。结果 28例受检者，共 476个心肌节段，双源CT首过扫描心肌灌 注共有371节段灌注减低及缺损，其中延 迟扫描共156个节段表现为低灌注，215 个节段表现为相对高灌注(延迟强化)； 99mTc-MIBI心肌灌注显影结果共有237心肌 灌注减低及缺损；17个节段中，共13节 段两者结果一致性好(Kappa值＞0.75)， 其余4节段(第2、3、8、9节段)一致性一 般(0.40＜Kappa值＜0.75)；第8节段敏 感度最高为(100%)，第12节段特异度为 最高为(100%)，第12节段准确度最高为 (92.85%)。结论 双源CT首过及延迟心肌 灌注成像评价心肌活性与99mTc-MIBI心肌 灌注显影对比结果一致性良好，可较为准 确地定位心肌梗死，并对心肌活性作出评 估。

Objective To evaluate the feasibility and diagnostic accuracy of firstpass and delayed enhancement of dual-energy computed tomography(DECT) in myocardial perfusion imaging for detecting myocardial viability compared with 99mTcMIBI myocardial perfusion imaging. Methods Twenty-eight patients with coronary artery disease were detected by first-pass and delayed enhancement (5min) DECT and 99mTc-MIBI PET respectively. A color-coded iodine map was used to evaluate the myocardial perfusion defects. Myocardial perfusion defects according to the firstpass and delayed enhancement were compared with 99mTc-MIBI myocardial perfusion imaging on a segmental basis. Results A total of 476 myocardial segments of 28 patients were analyzed. 371 segments showed perfusion decrease or defects on first-pass DECT, while 156 segments low perfusion and 215 segments relatively high perfusion on delayed enhancement DECT. 237 segments perfusion decrease or defects showed on 99mTc-MIBI myocardial perfusion imaging. Analysis is the assessment of myocardial viability revealed better agreement among 13 myocardial segments(kappa=1), good agreement among the left 4(2/3/8/9) myocardial segments(0.40 ＜kappa＜0.75).The 8th segments had the highest sensitivity(100%), the 12th segments had the highest specificity(100%), and the 12th segments had the highest accuracy(92.85%). Conclusion There is high agreement between first-pass and delayed enhancement of dual-energy computed tomography(DECT) and 99mTc-MIBI myocardial perfusion imaging for detecting myocardial viability, which is a promising method to location Myocardial infarction, and evaluate myocardial viability.