Weinsaft Jonathan W, Gade Christopher L, Wong Franklin J, Kim Han W, Min James K, Manoushagian Shant J, Okin Peter M, Szulc Massimiliano
Division of Cardiology, Department of Medicine, Weill Medical College of Cornell University, New York, NY 10021, USA.
J Nucl Cardiol. 2007 Sep-Oct;14(5):659-68. doi: 10.1016/j.nuclcard.2007.06.115.
Diagnostic assessment of myocardial perfusion impacts the management of patients with suspected coronary artery disease (CAD). Although various image displays are available for single photon emission computed tomography (SPECT) interpretation, the effects of display differences on SPECT interpretation remain undetermined.
We studied 183 patients undergoing SPECT, including 131 consecutive patients referred for angiography and 52 at low CAD risk. Studies were visually interpreted by use of color and gray images, with readers blinded to the results of the other display. In accordance with established criteria, a summed stress score (SSS) of 4 or greater was considered abnormal. The prevalence of abnormal SPECT findings was higher with gray images than with color images (54% vs 48%, P < .001) based on a uniform criterion (SSS > or =4). However, color images yielded equivalent sensitivity (79% vs 82%, P = .7) and improved specificity for global (50% vs 33%, P = .02) and vessel-specific CAD involving the right coronary artery (P < .01) and left anterior descending artery (P < .05). When the criterion for gray images was adjusted upward (SSS > or =5) to reflect increased mean defect severity (SSS of 5.1 vs 4.4, P = .01), gray and color images provided equivalent sensitivity and specificity for global and vessel-specific CAD.
SPECT interpretation can vary according to image display as a result of differences in perfusion defect severity. Adjustment of abnormality criteria for gray images to reflect minor increases in defect severity provides equivalent diagnostic performance of gray and color displays for CAD assessment.
心肌灌注的诊断评估会影响疑似冠心病（CAD）患者的治疗管理。尽管有多种图像显示方式可用于单光子发射计算机断层扫描（SPECT）解读，但显示差异对SPECT解读的影响仍未明确。
我们研究了183例接受SPECT检查的患者，其中包括131例连续接受血管造影检查的患者和52例CAD风险较低的患者。研究采用彩色和灰度图像进行视觉解读，阅片者对另一种显示结果不知情。根据既定标准，总应力评分（SSS）为4或更高被视为异常。基于统一标准（SSS≥4），灰度图像的SPECT异常发现患病率高于彩色图像（54%对48%，P<.001）。然而，彩色图像具有同等的敏感性（79%对82%，P=.7），并提高了对整体CAD（50%对33%，P=.02）以及涉及右冠状动脉（P<.01）和左前降支动脉（P<.05）的血管特异性CAD的特异性。当将灰度图像的标准上调（SSS≥5）以反映平均缺损严重程度增加（SSS为5.1对4.4，P=.01）时，灰度和彩色图像对整体和血管特异性CAD提供了同等的敏感性和特异性。
由于灌注缺损严重程度的差异，SPECT解读可能因图像显示而异。调整灰度图像的异常标准以反映缺损严重程度的轻微增加，可为CAD评估提供灰度和彩色显示同等的诊断性能。
