Berman Daniel S, Kang Xingping, Nishina Hidetaka, Slomka Piotr J, Shaw Leslee J, Hayes Sean W, Cohen Ishac, Friedman John D, Gerlach James, Germano Guido
Department of Imaging, Division of Nuclear Medicine, Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif 90048, USA.
J Nucl Cardiol. 2006 Mar-Apr;13(2):191-201. doi: 10.1007/BF02971243.
The diagnostic value of gated myocardial perfusion single-photon emission computed tomography (MPS) with combined supine and prone acquisitions to detect coronary artery disease (CAD) in obese and nonobese patients has not been defined.
We studied 1511 patients without prior myocardial infarction or coronary revascularization who either had coronary angiography within 3 months of MPS (n = 785) or had a low pretest likelihood of CAD (n = 726). All patients underwent rest thallium 201/gated exercise or adenosine stress technetium 99m sestamibi MPS in both the supine and prone positions. According to body mass index (BMI), patients were categorized as normal weight (BMI of 18.5-24.9 kg/m2), overweight (BMI of 25.0-29.9 kg/m2), or obese (BMI > or = 30.0 kg/m2). There were no significant differences in stress, fixed, or ischemic defects among patients in different weight categories. The sensitivity of MPS was 85%, 86%, and 89% for detecting patients with 50% or greater coronary stenosis and 89%, 91%, and 92% for detecting those with 70% or greater coronary stenosis in the normal-weight, overweight, and obese groups, respectively. Normalcy rates were nearly identical among the 3 weight groups (99%, 98%, and 99%, respectively). Multivariate logistic regression analysis further confirmed that BMI was a nonsignificant predictor for the detection of CAD. In a subset of 290 patients, automated quantitative MPS analysis confirmed that combined supine and prone MPS increased specificity (86%) in identifying CAD, without a significant reduction in sensitivity (83% for > or = 50% stenosis and 88% for > or = 70% stenosis).
The findings of this study suggest that MPS performed with gating and combined supine and prone acquisitions without attenuation correction had a similar diagnostic accuracy for the detection of CAD in normal-weight, overweight, and obese patients.
门控心肌灌注单光子发射计算机断层扫描（MPS）联合仰卧位和俯卧位采集用于检测肥胖和非肥胖患者冠状动脉疾病（CAD）的诊断价值尚未明确。
我们研究了1511例既往无心肌梗死或冠状动脉血运重建史的患者，这些患者要么在MPS检查后3个月内接受了冠状动脉造影（n = 785），要么CAD的预检可能性较低（n = 726）。所有患者均在仰卧位和俯卧位接受静息铊201/门控运动或腺苷负荷锝99m甲氧基异丁基异腈MPS检查。根据体重指数（BMI），患者被分为正常体重（BMI为18.5 - 24.9 kg/m²）、超重（BMI为25.0 - 29.9 kg/m²）或肥胖（BMI≥30.0 kg/m²）。不同体重类别的患者在负荷、固定或缺血性缺损方面无显著差异。在正常体重、超重和肥胖组中，MPS检测冠状动脉狭窄≥50%患者的敏感性分别为85%、86%和89%，检测冠状动脉狭窄≥70%患者的敏感性分别为89%、91%和92%。三个体重组的正常率几乎相同（分别为99%、98%和99%）。多因素逻辑回归分析进一步证实，BMI不是检测CAD的显著预测指标。在290例患者的亚组中，自动定量MPS分析证实，仰卧位和俯卧位联合MPS在识别CAD时可提高特异性（86%），而敏感性无显著降低（冠状动脉狭窄≥50%时为83%，冠状动脉狭窄≥70%时为88%）。
本研究结果表明，在无衰减校正的情况下，采用门控及仰卧位和俯卧位联合采集的MPS对正常体重、超重和肥胖患者CAD的检测具有相似的诊断准确性。
