Shirai Naoya, Yamagishi Hiroyuki, Yoshiyama Minoru, Teragaki Masakazu, Akioka Kaname, Takeuchi Kazuhide, Yoshikawa Junichi, Ochi Hironobu
Department of Internal Medicine and Cardiology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-ku, Osaka 545-8585, Japan.
J Nucl Med. 2002 Apr;43(4):443-50.
Assessment of reversible perfusion defects in exercise (201)Tl perfusion SPECT has low sensitivity and high specificity for detection of multivessel coronary artery disease (CAD). The goal of this study was to evaluate whether worsening of left ventricular regional wall motion assessed by an automated algorithm in exercise (201)Tl electrocardiography-gated SPECT had incremental diagnostic value over perfusion data for detection of multivessel CAD.
Two hundred one patients underwent exercise (201)Tl gated SPECT. Software that automatically analyzes left ventricular function was used to assess exercise and rest regional wall motion. Regional wall motion on initial images was compared with that on rest images, that is, delayed images for patients without reinjection images and reinjection images for patients with reinjection images. The left ventricle was divided into 9 segments, with individual segments assigned to 3 coronary territories. Worsening of wall motion was defined as worsening in any segment on initial images compared with rest images.
Of 73 patients with multivessel CAD, 20 (27.4%) had reversible perfusion defects in multiple coronary territories, 26 (35.6%) exhibited worsening of regional wall motion in multiple territories, and 37 (50.7%) had reversible perfusion defects or worsening of regional wall motion in multiple territories. The sensitivity of the combination of reversible perfusion defect and worsening of regional wall motion was significantly higher than that of reversible perfusion defect alone for detection of multivessel CAD (50.7% vs. 27.4%, P < 0.05). The specificity of the combination of reversible perfusion defect and worsening of regional wall motion for detecting multivessel CAD did not differ from that of reversible perfusion defect alone and that of worsening of regional wall motion alone (94.5% vs. 99.2% and 97.7%, respectively, P = not statistically significant).
Combined assessment of worsening of left ventricular regional wall motion by exercise and perfusion data in exercise (201)Tl gated myocardial SPECT was more sensitive, with acceptable specificity, than was assessment with perfusion data alone for detection of multivessel CAD.
运动负荷（201）铊心肌灌注单光子发射计算机断层显像（SPECT）中可逆性灌注缺损的评估对于多支冠状动脉疾病（CAD）的检测具有低敏感性和高特异性。本研究的目的是评估在运动负荷（201）铊心电图门控SPECT中，通过自动算法评估的左心室局部室壁运动恶化对于多支CAD检测而言，相较于灌注数据是否具有增量诊断价值。
201例患者接受了运动负荷（201）铊门控SPECT检查。使用自动分析左心室功能的软件来评估运动和静息状态下的局部室壁运动。将初始图像上的局部室壁运动与静息图像上的进行比较，即对于没有再注射图像的患者为延迟图像，对于有再注射图像的患者为再注射图像。左心室被分为9个节段，每个节段对应3个冠状动脉供血区域。室壁运动恶化定义为初始图像上的任何节段相较于静息图像出现恶化。
在73例多支CAD患者中，20例（27.4%）在多个冠状动脉供血区域存在可逆性灌注缺损，26例（35.6%）在多个区域表现出局部室壁运动恶化，37例（50.7%）在多个区域存在可逆性灌注缺损或局部室壁运动恶化。对于多支CAD的检测而言，可逆性灌注缺损与局部室壁运动恶化相结合的敏感性显著高于单独的可逆性灌注缺损（50.7%对27.4%，P<0.05）。可逆性灌注缺损与局部室壁运动恶化相结合用于检测多支CAD的特异性与单独的可逆性灌注缺损以及单独的局部室壁运动恶化的特异性无差异（分别为94.5%对99.2%和97.7%，P=无统计学意义）。
在运动负荷（201）铊门控心肌SPECT中，联合评估运动负荷下左心室局部室壁运动恶化和灌注数据对于多支CAD的检测比单独评估灌注数据更敏感，且特异性可接受。
