Schuijf Joanne D, Wijns William, Jukema J Wouter, Decramer Isabel, Atsma Douwe E, de Roos Albert, Stokkel Marcel P M, Dibbets-Schneider Petra, van der Wall Ernst E, Bax Jeroen J
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
J Nucl Med. 2006 Nov;47(11):1749-55.
For the noninvasive evaluation of coronary artery disease (CAD), both multislice CT and gated SPECT are available. How these 2 modalities relate, however, is yet unclear. The purpose of this study was to perform a head-to-head comparison of the results of multislice CT and gated SPECT on a regional basis (per vessel distribution territory) in patients with known or suspected CAD.
One hundred forty patients underwent both multislice CT for coronary calcium scoring and coronary angiography and gated SPECT for myocardial perfusion imaging. The coronary calcium score was determined for each coronary artery. Coronary arteries on multislice CT angiography were classified as having no CAD, insignificant stenosis (<50% luminal narrowing), significant stenosis, or total or subtotal occlusion (>/=90% luminal narrowing). Gated SPECT findings were classified as normal or abnormal (reversible or fixed defects) and were allocated to the territory of one of the various coronary arteries.
In coronary arteries with a calcium score of 10 or less, the corresponding myocardial perfusion was normal in 87% (n = 194/224). In coronary arteries with extensive calcifications (score > 400), the percentage of vascular territories with normal myocardial perfusion was lower, 54% (n = 13/24). Similarly, in most of the normal coronary arteries on multislice CT angiography, the corresponding myocardial perfusion was normal on SPECT (156/175, or 89%). In contrast, the percentage of normal SPECT findings was significantly lower in coronary arteries with obstructive lesions (59%) or with total or subtotal occlusions (8%) (P < 0.01). Nonetheless, only 48% of vascular territories with normal perfusion corresponded to normal coronary arteries on multislice CT angiography, whereas insignificant and significant stenoses were present in, respectively, 40% and 12% of corresponding coronary arteries.
Although a relationship exists between the severity of CAD on multislice CT and myocardial perfusion abnormalities on SPECT, analysis on a regional basis showed only moderate agreement between observed atherosclerosis and abnormal perfusion. Accordingly, multislice CT and gated SPECT provide complementary rather than overlapping information, and further studies should address how these 2 modalities can be integrated to optimize patient management.
对于冠状动脉疾病（CAD）的无创评估，多层螺旋CT和门控单光子发射计算机断层扫描（SPECT）均可使用。然而，这两种检查方式之间的关系尚不清楚。本研究的目的是在已知或疑似CAD患者中，对多层螺旋CT和门控SPECT的结果进行区域基础（按血管分布区域）的直接比较。
140例患者同时接受了用于冠状动脉钙化评分和冠状动脉造影的多层螺旋CT以及用于心肌灌注成像的门控SPECT检查。测定每条冠状动脉的冠状动脉钙化评分。多层螺旋CT血管造影上的冠状动脉被分类为无CAD、轻度狭窄（管腔狭窄<50%）、重度狭窄或完全或次全闭塞（管腔狭窄≥90%）。门控SPECT检查结果被分类为正常或异常（可逆或固定缺损），并分配到各条冠状动脉之一的区域。
在钙化评分为10或更低的冠状动脉中，相应心肌灌注正常的比例为87%（n = 194/224）。在有广泛钙化（评分>400）的冠状动脉中，心肌灌注正常的血管区域百分比更低，为54%（n = 13/24）。同样，在多层螺旋CT血管造影上大多数正常冠状动脉中，SPECT上相应的心肌灌注也是正常的（156/175，即89%）。相比之下，在有阻塞性病变（59%）或完全或次全闭塞（8%）的冠状动脉中，SPECT正常结果的百分比显著更低（P < 0.01）。尽管如此，在多层螺旋CT血管造影上，只有48%灌注正常的血管区域对应正常冠状动脉，而在相应冠状动脉中，分别有40%和12%存在轻度和重度狭窄。
虽然多层螺旋CT上CAD的严重程度与SPECT上的心肌灌注异常之间存在关联，但区域基础分析显示观察到的动脉粥样硬化与异常灌注之间仅存在中度一致性。因此，多层螺旋CT和门控SPECT提供的是互补而非重叠的信息，进一步的研究应探讨如何整合这两种检查方式以优化患者管理。
