Duvernoy C S, Ficaro E P, Karabajakian M Z, Rose P A, Corbett J R
Department of Internal Medicine, The University of Michigan Medical Center, Ann Arbor, USA.
J Nucl Cardiol. 2000 Nov-Dec;7(6):639-48. doi: 10.1067/mnc.2000.109454.
Myocardial perfusion imaging has demonstrated a limited sensitivity as a means of accurately identifying left main (LM) coronary disease. Because regional quantitative perfusion biases are eliminated with attenuation corrected (AC) single photon emission computed tomography (SPECT), as compared with uncorrected (NC) SPECT, we hypothesized that AC SPECT would demonstrate increased diagnostic accuracy for the detection of significant LM coronary stenosis.
We studied 28 patients (23 men, 5 women; mean age, 66+/-9 years) with significant LM stenoses (> or =50%) and 34 control patients (27 men, 7 women; mean age, 65+/-11 years) with 2-vessel coronary disease. Rest thallium-201 and stress technetium 99m sestamibi SPECT imaging with and without AC were performed, as described earlier. Both AC and NC images were analyzed visually and quantitatively in comparison with corresponding normal databases. A greater sensitivity for detection of an LM defect pattern (64% vs. 7%, P = .0009) with equivalent specificity (94% vs. 100%, P = not significant) was demonstrated by means of visual analysis of AC SPECT images. More disease was demonstrated in a greater number of territories with AC SPECT images than with NC images (2.14+/-0.97 for AC images vs. 1.43+/-0.84 for NC images, P = .0001). Similar improvement in the detection of LM disease was shown by means of automated quantitative analysis (57% for AC SPECT vs 14% for NC SPECT, P = .0005), again with no loss in specificity.
AC SPECT with the University of Michigan method in consecutive patients with LM stenoses and a select control population with severity matched multivessel coronary disease significantly improved the diagnostic accuracy of myocardial perfusion imaging for the identification of LM coronary disease, compared with uncorrected SPECT.
心肌灌注成像作为准确识别左主干（LM）冠状动脉疾病的手段，其敏感性有限。与未校正（NC）的单光子发射计算机断层扫描（SPECT）相比，由于衰减校正（AC）的SPECT消除了区域定量灌注偏差，我们推测AC SPECT在检测显著的LM冠状动脉狭窄方面将显示出更高的诊断准确性。
我们研究了28例患有显著LM狭窄（≥50%）的患者（23例男性，5例女性；平均年龄66±9岁）和34例患有双支冠状动脉疾病的对照患者（27例男性，7例女性；平均年龄65±11岁）。如前所述，进行了静息铊-201和负荷锝-99m甲氧基异丁基异腈SPECT成像，包括有AC和无AC的情况。将AC和NC图像与相应的正常数据库进行视觉和定量分析。通过对AC SPECT图像的视觉分析显示，检测LM缺损模式的敏感性更高（64%对7%，P = 0.0009），而特异性相当（94%对100%，P = 无显著差异）。与NC图像相比，AC SPECT图像在更多区域显示出更多病变（AC图像为2.14±0.97，NC图像为1.43±0.84，P = 0.0001）。通过自动定量分析也显示出在检测LM疾病方面有类似的改善（AC SPECT为57%，NC SPECT为14%，P = 0.0005），同样特异性没有降低。
与未校正的SPECT相比，采用密歇根大学方法对连续的LM狭窄患者和选择的严重程度匹配的多支冠状动脉疾病对照人群进行AC SPECT，显著提高了心肌灌注成像对LM冠状动脉疾病的诊断准确性。
