Katayama Takuji, Ogata Nobuhiko, Tsuruya Yoshio
Division of Cardiology, Tokyo-Kita Social Insurance Hospital, 4-17-56 Akabanedai, Kita-ku, Tokyo, Japan.
Ann Nucl Med. 2008 May;22(4):317-21. doi: 10.1007/s12149-008-0118-3. Epub 2008 Jun 6.
Prone thallium-201 ((201)Tl) myocardial perfusion single-photon emission computed tomography (SPECT) reduces false-positive rates when evaluating inferior wall abnormalities by minimizing diaphragmatic attenuation. The present study investigates the diagnostic validity of prone (201)Tl stress myocardial perfusion SPECT for detecting coronary artery disease in the inferior wall of the left ventricle in Japanese patients.
Of the 104 consecutive patients who underwent (201)Tl stress myocardial perfusion SPECT to diagnose coronary artery disease, we evaluated 46 who underwent image acquisition in both the supine and prone positions, and coronary angiography within 3 months thereafter. Images were acquired in the routine supine position immediately following (201)Tl (111 MBq) injection and 4 h following early acquisition. Images were acquired in the prone position only during the early phase following supine acquisition. We evaluated the SPECT images of the inferior half segments of the left ventricle using a five-point defect scoring system. According to the coronary angiographic findings, we investigated the diagnostic accuracy of stress-rest supine, stress supine, stress prone, and combined supine-prone images. Reduced uptake in the stress supine image of the combined images was considered as attenuation when uptake was normal in the prone image.
The sensitivity of the stress-rest supine, stress supine, stress prone, and stress-combined supine-prone images was 77%, 86%, 55%, and 55%, and the specificity was 71%, 54%, 79%, and 83%, respectively. Diagnostic accuracy was the highest in stress-rest supine images.
Prone images tended to improve the specificity of detecting coronary artery disease in the inferior wall, but not diagnostic accuracy compared with stress-rest supine images because of decreased sensitivity.
俯卧位铊-201（²⁰¹Tl）心肌灌注单光子发射计算机断层扫描（SPECT）通过最小化膈肌衰减，在评估下壁异常时可降低假阳性率。本研究调查俯卧位²⁰¹Tl负荷心肌灌注SPECT对日本患者左心室下壁冠状动脉疾病的诊断有效性。
在104例连续接受²⁰¹Tl负荷心肌灌注SPECT诊断冠状动脉疾病的患者中，我们评估了46例在仰卧位和俯卧位均进行图像采集且在之后3个月内接受冠状动脉造影的患者。在注射²⁰¹Tl（111 MBq）后立即在常规仰卧位采集图像，并在早期采集后4小时再次采集。仅在仰卧位采集后的早期阶段采集俯卧位图像。我们使用五分缺陷评分系统评估左心室下半段的SPECT图像。根据冠状动脉造影结果，我们研究了静息-负荷仰卧位、负荷仰卧位、负荷俯卧位和仰卧位-俯卧位联合图像的诊断准确性。当联合图像的负荷仰卧位图像摄取减少而俯卧位图像摄取正常时，将其视为衰减。
静息-负荷仰卧位、负荷仰卧位、负荷俯卧位和负荷-仰卧位-俯卧位联合图像的敏感性分别为77%、86%、55%和55%，特异性分别为71%、54%、79%和83%。诊断准确性在静息-负荷仰卧位图像中最高。
俯卧位图像倾向于提高下壁冠状动脉疾病检测的特异性，但与静息-负荷仰卧位图像相比，由于敏感性降低，并未提高诊断准确性。
