DePuey E G, Parmett S, Ghesani M, Rozanski A, Nichols K, Salensky H
Department of Radiology, St. Luke's Roosevelt Hospital and Columbia University, College of Physicians and Surgeons, New York, NY 10025, USA.
J Nucl Cardiol. 1999 May-Jun;6(3):278-85. doi: 10.1016/s1071-3581(99)90040-5.
To determine the interpretability of gated thallium-201 perfusion SPECT compared with that performed by use of technetium-99m sestamibi (MIBI), 33 patients with prior myocardial infarction were studied. Patients received 22 to 30 mCi (814 to 1110 MBq) MIBI at peak stress, and a 15-minute gated SPECT acquisition was begun 30 to 40 minutes thereafter. On a subsequent day gated Tl-201 SPECT was acquired for 15 minutes, 4 hours after a resting 3.5 mCi (130 MBq) injection. SPECT was performed over a 180-degree arc by use of a 90-degree angled 2-detector camera.
Gated studies were interpreted independently by 4 experienced physicians. Study quality was graded (0 = uninterpretable to 4 = excellent). Wall motion (0 = normal to 2 = akinetic/dyskinetic) and wall thickening (0 = normal to 2 = absent) were graded for each of 10 segments viewed in orthogonal planes. Left ventricular ejection fraction (LVEF) was calculated by use of software thus far validated only for MIBI. The average count density of mid-ventricular end-diastolic short axis tomograms with sestamibi was 3.47 times greater than with thallium. Mean study quality was 3.4 for MIBI and 1.8 for thallium (P < 10(-6)). No gated MIBI SPECTs, but 2 gated thallium studies (6%) were judged uninterpretable. Among interpretable scans, interobserver agreement (Kendall statistic) in assessing wall motion was 0.73 for MIBI and 0.66 for thallium (P = .01). For assessing wall thickening, the Kendall statistic was 0.73 for MIBI and 0.69 for thallium (P = .05). Correlation (r) of LVEFs was 0.91, SEE = 6.4.
We conclude that gated thallium SPECT is inferior to MIBI because of much poorer image quality and somewhat poorer interobserver agreement among experienced physicians. However, LVEF can be determined reliably from gated thallium SPECT.
为了确定门控铊 - 201灌注单光子发射计算机断层扫描（SPECT）与使用锝 - 99m 甲氧基异丁基异腈（MIBI）进行的扫描相比的可解释性，对33例既往有心肌梗死的患者进行了研究。患者在峰值应力时接受22至30毫居里（814至1110兆贝可）的MIBI，此后30至40分钟开始进行15分钟的门控SPECT采集。在随后的一天，在静息注射3.5毫居里（130兆贝可）铊 - 201 4小时后，进行15分钟的门控铊 - 201 SPECT采集。使用90度角的双探测器相机在180度弧上进行SPECT检查。
4位经验丰富的医生独立解读门控研究。研究质量进行分级（0 = 不可解读至4 = 优秀）。对在正交平面上观察的10个节段中的每一个节段进行室壁运动分级（0 = 正常至2 = 运动减弱/运动障碍）和室壁增厚分级（0 = 正常至2 = 无增厚）。左心室射血分数（LVEF）使用目前仅针对MIBI验证的软件进行计算。使用MIBI时，心室舒张末期短轴断层图像的平均计数密度比使用铊时高3.47倍。MIBI研究的平均质量评分为3.4，铊研究为1.8（P < 10^(-6)）。没有门控MIBI SPECT被判定为不可解读，但有2项门控铊研究（6%）被判定为不可解读。在可解读的扫描中，经验丰富的医生在评估室壁运动时的观察者间一致性（肯德尔统计量），MIBI为0.73，铊为0.66（P = 0.01）。在评估室壁增厚时，MIBI的肯德尔统计量为0.73，铊为0.69（P = 0.05）。LVEF的相关性（r）为0.91，标准误（SEE）为6.4。
我们得出结论，门控铊SPECT不如MIBI，因为其图像质量差得多，且经验丰富的医生之间的观察者间一致性也稍差。然而，可以从门控铊SPECT可靠地确定LVEF。
