Cachin Florent, Lipiecki Janusz, Mestas Danièle, Amonchot Aimé, Geissler Benjamin, Thouly Cyril, Ponsonnaille Jean, Maublant Jean
Division of Nuclear Medicine, Jean Perrin Cancer Center, Clermont-Ferrand, France.
J Nucl Med. 2003 Oct;44(10):1625-32.
This study validates a new quantitative myocardial perfusion SPECT software.
The processing starts with the extraction of the morphologic skeleton of the left ventricular myocardium from reconstructed transverse sections. Fuzzy logic is used to decide whether a pixel belongs to the myocardium and any perfusion defect is filled according to a truncated bullet model. The resulting image is partitioned in 18 isovolumetric sectors. Sex-matched normal limits, criteria of abnormality for rest (201)Tl and (99m)Tc-labeled perfusion tracers, reproducibility studies, and detection of coronary artery disease were developed and validated in an overall population of 343 patients. The sex- and tracer-matched means and SDs of a normal response were calculated in 93 male and 93 female patients with a <5% likelihood of coronary artery disease. Reproducibility measurements and assignment of different sectors of the myocardium to a specific coronary were performed from data collected in 49 and 60 patients, respectively. The accuracy of the detection of a coronary artery occlusion was assessed in 48 patients who also underwent coronary angiography.
The intra- and interoperator reproducibility of the sectorial activity was high with a linear regression coefficient of 0.97 and a SD of the difference measurement at 4.4% and 3.8%, respectively. Overall sensitivity and specificity for the detection of occluded coronary artery were 90% and 80%, respectively. For the detection of left anterior descending, left circumflex, and right artery coronary occlusion, sensitivity was 92%, 75%, and 92.5%, respectively, and specificity was 75%, 78%, and 90%, respectively.
The new quantitative myocardial perfusion SPECT software appears to be a very helpful program for the objective analysis of perfusion tracer distribution in myocardial SPECT and a very accurate tool in the detection and localization of coronary artery occlusion.
本研究验证了一种新的定量心肌灌注单光子发射计算机断层扫描（SPECT）软件。
处理过程始于从重建的横断面中提取左心室心肌的形态学骨架。使用模糊逻辑来确定一个像素是否属于心肌，并根据截断的子弹模型填充任何灌注缺损。所得图像被划分为18个等容扇形区。在343例患者的总体人群中制定并验证了性别匹配的正常范围、静息（201）铊和（99m）锝标记灌注示踪剂的异常标准、可重复性研究以及冠状动脉疾病的检测。在93例男性和93例女性冠状动脉疾病可能性<5%的患者中计算了正常反应的性别和示踪剂匹配的均值及标准差。分别从49例和60例患者收集的数据中进行了可重复性测量以及将心肌的不同扇形区分配到特定冠状动脉。在48例同时接受冠状动脉造影的患者中评估了冠状动脉闭塞检测的准确性。
扇形区活性的操作者内和操作者间可重复性很高，线性回归系数为0.97，差异测量的标准差分别为4.4%和3.8%。检测闭塞冠状动脉的总体敏感性和特异性分别为90%和80%。对于检测左前降支、左旋支和右冠状动脉闭塞，敏感性分别为92%、75%和92.5%，特异性分别为75%、78%和90%。
新的定量心肌灌注SPECT软件似乎是一个非常有用的程序，用于心肌SPECT中灌注示踪剂分布的客观分析，也是检测和定位冠状动脉闭塞的非常准确的工具。
