采用一种新的自动技术测定运动后肺对99mTc-司他米比的摄取：在严重和广泛冠状动脉疾病及左心室功能降低检测中的验证与应用

Postexercise lung uptake of 99mTc-sestamibi determined by a new automatic technique: validation and application in detection of severe and extensive coronary artery disease and reduced left ventricular function.

作者信息

Bacher-Stier C, Sharir T, Kavanagh P B, Lewin H C, Friedman J D, Miranda R, Germano G, Berman D S

机构信息

Department of Imaging, Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.

出版信息

J Nucl Med. 2000 Jul;41(7):1190-7.

PMID:10914908

Abstract

UNLABELLED

This study validated a new automatic algorithm for assessment of lung-to-heart ratio (L/H) of radiotracers in myocardial perfusion SPECT and assessed the diagnostic value of (99m)Tc-sestamibi L/H after exercise.

METHODS

The new technique extracts a left ventricular region of interest (ROI) from a summed anterior projection image and generates a lung ROI by reshaping and translating the left ventricular ROI. This algorithm was applied to 230 patients who underwent exercise (99m)Tc-sestamibi SPECT (gated SPECT, n = 88) with first-pass ventriculography. Normal values were established in 26 patients in whom the likelihood of coronary artery disease (CAD) was 5% or less. An abnormality threshold for detecting severe and extensive CAD was defined in a subgroup of 109 patients who underwent coronary angiography and was validated in a prospective group (n = 72).

RESULTS

The success rate of the automatic algorithm was 97%. Excellent correlation was found between automatic and manual L/H values (r = 0.95; P < 0.001). The mean L/H was higher in patients with a peak exercise ejection fraction (EF) less than 40% versus 40% or more (0.51 +/- 0.07 versus 0.43 +/- 0.05, P < 0.001) and in patients with a poststress EF less than 40% versus 40% or more (0.50 +/- 0.07 versus 0.44 +/- 0.06, P < 0.01). A threshold of L/H greater than 0.44 yielded a sensitivity and specificity of 63% and 81%, respectively, for identifying severe and extensive CAD in the prospective group and a sensitivity of 86% in identifying stenosis of 90% or more in the proximal left anterior descending artery.

CONCLUSION

The new automatic algorithm for assessing L/H correlated well with manually derived L/H for (99m)Tc-sestamibi as well as (201)TI SPECT. An increased postexercise (99m)Tc-sestamibi L/H adds significant diagnostic value to study myocardial perfusion SPECT as a marker of severe and extensive CAD and reduced ventricular function.

摘要

未标注

本研究验证了一种用于评估心肌灌注单光子发射计算机断层扫描（SPECT）中放射性示踪剂肺心比（L/H）的新自动算法，并评估了运动后（99m）锝-司他比L/H的诊断价值。

方法

新技术从总和前位投影图像中提取左心室感兴趣区（ROI），并通过重塑和平移左心室ROI生成肺ROI。该算法应用于230例行运动（99m）锝-司他比SPECT（门控SPECT，n = 88）及首次通过心室造影的患者。在26例冠状动脉疾病（CAD）可能性为5%或更低的患者中确定正常值。在109例行冠状动脉造影的患者亚组中定义检测严重和广泛CAD的异常阈值，并在前瞻性组（n = 72）中进行验证。

结果

自动算法的成功率为97%。自动和手动L/H值之间发现极好的相关性（r = 0.95；P < 0.001）。运动峰值射血分数（EF）小于40%的患者与40%或更高的患者相比，平均L/H更高（0.51±0.07对0.43±0.05，P < 0.001），且应激后EF小于40%的患者与40%或更高的患者相比，平均L/H更高（0.50±0.07对0.44±0.06，P < 0.01）。L/H大于0.44的阈值在瞻性组中识别严重和广泛CAD的敏感性和特异性分别为63%和81%，在识别左前降支近端90%或更高狭窄方面的敏感性为86%。