正电子发射断层扫描测量腺苷刺激后的绝对心肌血流量与相对心肌示踪剂含量用于评估冠状动脉狭窄严重程度和位置的生理比较
Comparison of positron emission tomography measurement of adenosine-stimulated absolute myocardial blood flow versus relative myocardial tracer content for physiological assessment of coronary artery stenosis severity and location.
作者信息
Hajjiri Mohammad M, Leavitt Marcia B, Zheng Hui, Spooner Amy E, Fischman Alan J, Gewirtz Henry
机构信息
Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
出版信息
JACC Cardiovasc Imaging. 2009 Jun;2(6):751-8. doi: 10.1016/j.jcmg.2009.04.004.
OBJECTIVES
This study tests the hypothesis that absolute measurement of adenosine (Ado)-stimulated myocardial blood flow (MBFado) is superior to measurement of relative tracer uptake for identification of hemodynamically significant coronary artery disease (CAD).
BACKGROUND
Positron emission tomography measurement of absolute myocardial blood flow (MBF) ((13)N-ammonia) with Ado has the capability to more accurately assess hemodynamic severity of CAD than measurement of relative tracer content (TC) (nCi/ml) during Ado, which by definition depends on at least 1 normal zone to which others are compared.
METHODS
A total of 27 patients (20 male, 58 +/- 11 years, mean +/- SD) with known or suspected CAD and 21 normal subjects (13 male, 38 +/- 10 years) were studied. Parametric (K1) MBF images and TC sum images were analyzed. A stenosis > or =70% defined significant CAD. The receiver-operator characteristic curve (ROC) analysis area under the curve (AUC) compared MBF and TC results. Cut-point analysis for sensitivity, specificity, and accuracy showed the best MBF criteria for CAD as MBFado <1.85 ml/min/g and the best TC as <70% maximum. The myocardial blood flow reserve ratio (MBFR) (optimal <2.0x) also was studied.
RESULTS
The ROC analysis of PET parameters showed that MBFado was superior to <70% maximum uptake for CAD detection (n = 144 vessels; AUC 0.900 vs. 0.690, respectively, p < 0.0001) and was marginally greater than MBFR (0.856; p = 0.10). For CAD cut-point analysis, MBFado accuracy exceeded TC (0.84 vs. 0.72, respectively, p = 0.005), as did sensitivity (0.81 vs. 0.48, respectively; p = 0.001). Specificity of MBFado for CAD classification (0.85) was comparable to TC (0.82; p = NS). Sensitivity, specificity, and predictive accuracy for MBFR were 0.62, 0.85, and 0.79, respectively. The difference in specificity was not significant versus MBFado. However, MBFado was more sensitive than MBFR (p = 0.01). The difference in predictive accuracy was borderline (p = 0.06) in favor of MBFado.
CONCLUSIONS
Measurement of Ado-stimulated absolute MBF is superior to relative measurement of myocardial tracer retention for identification of CAD and can be accomplished with a single MBFado measurement.
目的
本研究检验以下假设，即腺苷（Ado）刺激的心肌血流量（MBFado）的绝对测量在识别具有血流动力学意义的冠状动脉疾病（CAD）方面优于相对示踪剂摄取测量。
背景
用Ado进行正电子发射断层扫描测量绝对心肌血流量（MBF）（（13）N - 氨）比测量Ado期间的相对示踪剂含量（TC）（nCi/ml）更有能力准确评估CAD的血流动力学严重程度，相对示踪剂含量测量根据定义至少依赖于一个与其他区域进行比较的正常区域。
方法
共研究了27例已知或疑似CAD的患者（20例男性，年龄58±11岁，平均±标准差）和21例正常受试者（13例男性，年龄38±10岁）。分析了参数化（K1）MBF图像和TC总和图像。狭窄≥70%定义为显著CAD。通过曲线下面积（AUC）的受试者工作特征曲线（ROC）分析比较了MBF和TC结果。敏感性、特异性和准确性的切点分析显示，CAD的最佳MBF标准为MBFado<1.85 ml/min/g，最佳TC标准为<最大摄取量的70%。还研究了心肌血流储备率（MBFR）（最佳<2.0倍）。
结果
PET参数的ROC分析表明，MBFado在CAD检测方面优于最大摄取量<70%（n = 144支血管；AUC分别为0.900和0.690，p<0.0001），且略大于MBFR（0.856；p = 0.10）。对于CAD切点分析，MBFado的准确性超过TC（分别为0.84和0.72，p = 0.005），敏感性也是如此（分别为0.81和0.48；p = 0.001）。MBFado对CAD分类的特异性（0.85）与TC（0.82；p = 无显著性差异）相当。MBFR的敏感性、特异性和预测准确性分别为0.62、0.85和0.79。与MBFado相比，特异性差异不显著。然而，MBFado比MBFR更敏感（p = 0.
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