Matoh Fumitaka, Tawarahara Kei, Mikami Naoshi, Nomura Noriyuki, Odagiri Keiichi, Saito Norihito, Takeuchi Yasuyo, Hayashi Hideharu, Terada Hajime, Satoh Hiroshi, Uehara Akihiko, Kurata Chinori
Department of Cardiology, Hamamatsu Red Cross Hospital, Shizuoka.
J Cardiol. 2005 Oct;46(4):131-40.
Increased pulmonary or right ventricular 201Tl uptake during the exercise test has been used as a marker of multivessel coronary artery disease. The most useful method for assessing the severity of coronary artery disease was evaluated among conventional evaluation of single photon emission computed tomography (SPECT), measurement of lung to heart uptake ratio (L/H), and right ventricular to left ventricular uptake ratio (RV/LV) on 201Tl images during exercise testing.
Regions-of-interest (4 X 4 pixels) were placed at the lung and the heart, and L/H was defined as mean lung uptake/mean heart uptake. Correspondingly, regions-of-interest (4 X 4 pixels) were placed at the RV and the LV, and RV/LV was defined as maximum RV uptake /maximum LV uptake. L/H and RV/LV on the initial image were analyzed in 216 patients(angiographically normal coronary arteries: 89, single-vessel disease: 82, multivessel disease: 45). The diagnostic value was evaluated using the receiver operating characteristic curve.
All methods showed significantly higher values in patients with multivessel disease than in patients with no coronary artery disease or single-vessel disease. L/H was significantly higher in patients with prior myocardial infarction and RV/LV was significantly higher in patients without infarction. The sensitivity of only conventional SPECT evaluation for multivessel coronary artery disease was low (sensitivity 53%, specificity 94%). However, addition of evaluation of L/H and RV/LV to SPECT improved the sensitivity for multivessel coronary artery disease (sensitivity 93%, specificity 49%).
The diagnostic sensitivity for multivessel coronary artery disease was improved by adding L/H and RV/LV to conventional evaluation of exercise 201Tl SPECT. L/H and RV/LV during exercise 201Tl imaging may provide additional information regarding the severity of coronary artery disease.
运动试验期间肺或右心室201铊摄取增加已被用作多支冠状动脉疾病的标志物。在运动试验期间，对单光子发射计算机断层扫描（SPECT）的传统评估、肺与心脏摄取比值（L/H）的测量以及201铊图像上右心室与左心室摄取比值（RV/LV）的测量中，评估了评估冠状动脉疾病严重程度的最有用方法。
在肺和心脏处放置感兴趣区（4×4像素），L/H定义为平均肺摄取/平均心脏摄取。相应地，在右心室和左心室处放置感兴趣区（4×4像素），RV/LV定义为最大右心室摄取/最大左心室摄取。对216例患者（冠状动脉造影正常：89例，单支血管疾病：82例，多支血管疾病：45例）的初始图像上的L/H和RV/LV进行分析。使用受试者工作特征曲线评估诊断价值。
所有方法在多支血管疾病患者中的值均显著高于无冠状动脉疾病或单支血管疾病的患者。有心肌梗死病史的患者L/H显著更高，无梗死的患者RV/LV显著更高。仅传统SPECT评估对多支冠状动脉疾病的敏感性较低（敏感性53%，特异性94%）。然而，在SPECT中加入L/H和RV/LV评估可提高对多支冠状动脉疾病的敏感性（敏感性93%，特异性为49%）。
通过在运动201铊SPECT的传统评估中加入L/H和RV/LV，提高了对多支冠状动脉疾病的诊断敏感性。运动201铊成像期间的L/H和RV/LV可能提供有关冠状动脉疾病严重程度的额外信息。
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