Aepfelbacher F C, Johnson R B, Schwartz J G, Chen L, Parker R A, Parker J A, Danias P G
Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA.
Eur J Nucl Med. 2001 Nov;28(11):1624-9. doi: 10.1007/s002590100618.
Several models of left ventricular segmentation have been developed that assume a standard coronary artery distribution, and are currently used for interpretation of single-photon emission tomography (SPET) myocardial perfusion imaging. This approach has the potential for incorrect assignment of myocardial segments to vascular territories, possibly over- or underestimating the number of vessels with significant coronary artery disease (CAD). We therefore sought to validate a 17-segment model of myocardial perfusion by comparing the predefined coronary territory assignment with the actual angiographically derived coronary distribution. We examined 135 patients who underwent both coronary angiography and stress SPET imaging within 30 days. Individualized coronary distribution was determined by review of the coronary angiograms and used to identify the coronary artery supplying each of the 17 myocardial segments of the model. The actual coronary distribution was used to assess the accuracy of the assumed coronary distribution of the model. The sensitivities and specificities of stress SPET for detection of CAD in individual coronary arteries and the classification regarding perceived number of diseased coronary arteries were also compared between the two coronary distributions (actual and assumed). The assumed coronary distribution corresponded to the actual coronary anatomy in all but one segment (#3). The majority of patients (80%) had 14 or more concordant segments. Sensitivities and specificities of stress SPET for detection of CAD in the coronary territories were similar, with the exception of the RCA territory, for which specificity for detection of CAD was better for the angiographically derived coronary artery distribution than for the model. There was 95% agreement between assumed and angiographically derived coronary distributions in classification to single- versus multi-vessel CAD. Reassignment of a single segment (segment #3) from the LCX to the LAD territory further improved the model's fit with the anatomic data. It is concluded that left ventricular segmentation using a model with assumed coronary artery distribution is valid for interpretation of SPET myocardial perfusion imaging.
已经开发了几种左心室分割模型，这些模型假定冠状动脉分布标准，目前用于解释单光子发射断层扫描（SPET）心肌灌注成像。这种方法有可能将心肌节段错误地分配到血管区域，可能高估或低估患有严重冠状动脉疾病（CAD）的血管数量。因此，我们试图通过将预定义的冠状动脉区域分配与实际血管造影得出的冠状动脉分布进行比较，来验证心肌灌注的17节段模型。我们检查了135例在30天内同时接受冠状动脉造影和负荷SPET成像的患者。通过回顾冠状动脉造影确定个体化冠状动脉分布，并用于识别为模型的17个心肌节段中的每一个供血的冠状动脉。实际冠状动脉分布用于评估模型假定冠状动脉分布的准确性。还比较了两种冠状动脉分布（实际和假定）之间负荷SPET检测各冠状动脉CAD的敏感性和特异性，以及关于感知的病变冠状动脉数量的分类。除了一个节段（#3）外，假定冠状动脉分布与实际冠状动脉解剖结构相符。大多数患者（80%）有14个或更多一致的节段。负荷SPET检测冠状动脉区域CAD的敏感性和特异性相似，但右冠状动脉区域除外，对于该区域，血管造影得出的冠状动脉分布检测CAD的特异性优于模型。在单支与多支CAD分类中，假定冠状动脉分布与血管造影得出的冠状动脉分布之间有95%的一致性。将一个节段（节段#3）从左旋支重新分配到左前降支区域进一步改善了模型与解剖数据的拟合度。结论是，使用具有假定冠状动脉分布的模型进行左心室分割对于解释SPET心肌灌注成像是有效的。
