Robinson Vincent J B, Patel Rakesh N, Nalamolu Venkata R P, Kaminski Robert J, Dias James K, Thornton John W, Kersey Terry W, Mandawat Mahendra K
Department of Medicine and Radiology, Medical College of Georgia and Veterans Affair Medical Center, Augusta, GA 30912, USA.
Nucl Med Commun. 2008 Mar;29(3):222-9. doi: 10.1097/MNM.0b013e3282f3d02e.
Myocardial perfusion imaging is subject to considerable noise due to re-registration and attenuation artifact.
On a retrospective review, we identified 51 studies that showed encircling reperfusion pattern on a stress-minus-delay bull's-eye map with concurrent cardiac catheterization within 4 months. Encircling reperfusion was defined as a band of reversibility > or =2.5 standard deviations above that of the gender-matched and age-matched normal studies. This had to surround the delay defect for at least two-thirds of its circumference on the stress-minus-delay bull's-eye map. Three expert readers, blinded to cardiac catheterization results, individually interpreted myocardial perfusion imaging without and with a stress-minus-delay bull's-eye map. A certainty index of 1-100 (100 being the highest certainty for the presence of perfusion defects) was recorded for image interpretation.
The intra-class correlation coefficient between readers indicated a strong agreement. Using encircling reperfusion pattern on a stress-minus-delay bull's-eye map, the mean increase in certainty index scores was 8.0+/-7.30 (P<0.0001). This increase in certainty index scores was associated with a significant increase in sensitivity from 67 to 83% (P=0.01) without any significant decrease in specificity (P=0.16).
The pattern of encircling reperfusion on the stress-minus-delay bull's-eye map can improve the interpreter's confidence and sensitivity without significantly compromising specificity for identifying true myocardial perfusion defects.
由于重新配准和衰减伪影，心肌灌注成像存在相当大的噪声。
在一项回顾性研究中，我们确定了51项研究，这些研究显示在应激减去延迟的靶心图上出现环形再灌注模式，且在4个月内同时进行了心导管检查。环形再灌注被定义为可逆性带，比性别匹配和年龄匹配的正常研究高出或等于2.5个标准差。在应激减去延迟的靶心图上，这必须围绕延迟缺损至少三分之二的周长。三位不了解心导管检查结果的专家读者分别对有无应激减去延迟靶心图的心肌灌注成像进行解读。记录图像解读的确定性指数为1 - 100（100表示存在灌注缺损的最高确定性）。
读者之间的组内相关系数表明一致性很强。使用应激减去延迟靶心图上的环形再灌注模式，确定性指数评分的平均增加为8.0±7.30（P<0.0001）。确定性指数评分的这种增加与敏感性从67%显著提高到83%相关（P = 0.01），而特异性没有任何显著降低（P = 0.16）。
应激减去延迟靶心图上的环形再灌注模式可以提高解读人员的信心和敏感性，而不会显著损害识别真正心肌灌注缺损的特异性。
