Vallejo Enrique, Acevedo César, Varela Samuel, Alburez José Carlos, Bialostozky David
Servicio de Cardiología Nuclear, Instituto Nacional de Cardiología Ignacio Chávez, México.
Gac Med Mex. 2012 Jan-Feb;148(1):6-13.
Single photon emission computed tomography (SPECT) myocardial perfusion imaging is widely used for diagnosing coronary artery disease (CAD). However, SPECT costs, imaging time, and radiation exposure, limit SPECT indications.
Determine whether a stress-only SPECT imaging would be enough to obtain a diagnosis of CAD improving nuclear laboratory efficiency.
122 patients with unknown CAD were evaluated with stress-only SPECT imaging. In order to evaluate diagnostic accuracy and the prognostic value of the stress-only protocol, patients with abnormal SPECT underwent invasive angiography and patients with normal SPECT were followed-up during 3 years.
Diagnosis time, SPECT cost, and radiopharmaceutical dosage were significantly lower as compared with the conventional SPECT imaging protocol (30, 40 and 55%, respectively). Diagnostic accuracy and cardiac prognosis information were comparable to those obtained with the conventional imaging protocol (positive predictive value for CAD of 85% and negative predictive value for cardiac events of 97%).
In patients with intermediate risk for CAD, stress-only SPECT imaging will significantly improve nuclear laboratory efficiency, and with similar accuracy than that the one obtained with the conventional protocol.
单光子发射计算机断层扫描（SPECT）心肌灌注成像广泛应用于冠状动脉疾病（CAD）的诊断。然而，SPECT的成本、成像时间和辐射暴露限制了其应用指征。
确定仅进行负荷SPECT成像是否足以诊断CAD，同时提高核医学实验室的效率。
对122例CAD情况不明的患者进行仅负荷SPECT成像评估。为评估仅负荷方案的诊断准确性和预后价值，SPECT异常的患者接受有创血管造影检查，SPECT正常的患者进行3年随访。
与传统SPECT成像方案相比，诊断时间、SPECT成本和放射性药物剂量显著降低（分别降低30%、40%和55%）。诊断准确性和心脏预后信息与传统成像方案相当（CAD的阳性预测值为85%，心脏事件的阴性预测值为97%）。
对于CAD中度风险患者，仅负荷SPECT成像将显著提高核医学实验室的效率，且准确性与传统方案相似。
