Husmann Lars, Wiegand Mischa, Valenta Ines, Gaemperli Oliver, Schepis Tiziano, Siegrist Patrick T, Namdar Mehdi, Wyss Christophe A, Alkadhi Hatem, Kaufmann Philipp A
Cardiovascular Center, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland.
Int J Cardiovasc Imaging. 2008 Jun;24(5):511-8. doi: 10.1007/s10554-007-9288-7. Epub 2007 Dec 25.
The aim of this study was to compare the diagnostic accuracy of myocardial perfusion imaging (MPI) by positron emission tomography (PET) with the diagnostic accuracy of MPI by single photon emission computed tomography (SPECT) in two comparable patient cohorts, using coronary angiography (CA) as the standard of reference.
A "SPECT-group" of 80 patients (15 female, 65 male; mean age 60+/-9 years) and a "PET-group" of 70 patients (14 female, 56 male; mean age 57+/-10 years) underwent a one day stress/rest examination either with attenuation-corrected (13)N-ammonia PET or attenuation-corrected (201)TlCl SPECT or (99m)Tc-hexakis-methoxy-isobutyl-isonitril (MIBI) SPECT. PET and SPECT results were semiquantitatively graded using a 6-segment heart model. All patients underwent CA, and stenoses were graded as a diameter reduction >or=50%.
Coronary findings between both groups did not significantly differ at CA. For the SPECT-group overall sensitivity and specificity for localisation of stenoses was 77% and 84%. Respective values for the PET-group were 97% and 84%. The specificity of MPI by SPECT in the detection of ischemia was 74% and 91% for MPI by PET. The diagnostic accuracy of MPI improves when the individual coronary dominance and previous coronary revascularisations are taken into account.
MPI by (13)N-ammonia PET is more sensitive in the detection and localisation of coronary stenoses, and more specific in the detection of ischemia than MPI by (201)TlCl/(99m)MIBI SPECT.
本研究旨在以冠状动脉造影（CA）作为参考标准，比较正电子发射断层扫描（PET）心肌灌注成像（MPI）与单光子发射计算机断层扫描（SPECT）心肌灌注成像在两个可比患者队列中的诊断准确性。
“SPECT组”80例患者（15例女性，65例男性；平均年龄60±9岁）和“PET组”70例患者（14例女性，56例男性；平均年龄57±10岁）接受了为期一天的负荷/静息检查，采用衰减校正的（13）N-氨PET或衰减校正的（201）TlCl SPECT或（99m）Tc-六甲氧基异丁基异腈（MIBI）SPECT。PET和SPECT结果使用6节段心脏模型进行半定量分级。所有患者均接受冠状动脉造影，狭窄程度分级为直径减少≥50%。
两组间冠状动脉造影结果无显著差异。SPECT组狭窄定位的总体敏感性和特异性分别为77%和84%。PET组的相应值分别为97%和84%。SPECT心肌灌注成像检测缺血的特异性为74%，PET心肌灌注成像为91%。考虑个体冠状动脉优势和既往冠状动脉血运重建时，心肌灌注成像的诊断准确性提高。
（13）N-氨PET心肌灌注成像在检测和定位冠状动脉狭窄方面比（201）TlCl/（99m）MIBI SPECT心肌灌注成像更敏感，在检测缺血方面更具特异性。
