Kiat H, Van Train K F, Maddahi J, Corbett J R, Nichols K, McGhie A I, Akers M S, Friedman J D, Roy L, Berman D S
Department of Medicine (Division of Cardiology), Cedars-Sinai Medical Center, Los Angeles, CA 90048.
Am Heart J. 1990 Dec;120(6 Pt 1):1255-66. doi: 10.1016/0002-8703(90)90234-o.
The clinical diagnostic accuracy of 2-day stress/rest quantitative Technetium-99m (Tc-99m) methoxy-isobutyl-isonitrile (Tc-sestamibi) single photon emission computerized tomography (SPECT) was assessed in a validation population of 61 patients from two different sites using two different camera/computer systems. The study population was made up of 53 catheterized patients, 29 from Cedars-Sinai Medical Center (CSMC) and 24 from the University of Texas Southwestern Medical Center (UTSMC), and eight UTSMC patients with a less than 5% pre-test likelihood of coronary artery disease. Interpretation employed gender-specific normal limits developed in an additional 15 men and 8 women at CSMC with less than a 5% likelihood of significant coronary artery disease. The results from CSMC compared with those from UTSMC were not different from each other. The overall sensitivity for detection of patients with coronary artery disease (greater than or equal to 50% stenosis) was 94% (CSMC: 92%, UTSMC: 95%). Overall specificity in the five patients with normal coronary arteriograms was 80% (CSMC: 67%, UTSMC: 100%). The normalcy rate in patients with a low likelihood of coronary artery disease was 88%. Vessel sensitivity was 85% (CSMC: 84%, UTSMC: 85%), while vessel specificity was 71% (CSMC: 72%, UTSMC: 69%). There was also no significant difference in the sensitivities and specificities between male and female populations. In addition, the agreement with coronary angiography for assessment of disease extent (normal coronary arteriogram, single or multivessel disease) was 75% (kappa = 0.6 +/- 0.1). This study demonstrated that Tc-sestamibi SPECT by quantitative analysis is accurate for the detection and localization of coronary artery disease. Furthermore, the CSMC quantitative method was shown to provide similar diagnostic accuracy when applied to data acquired at a different site using a different camera/computer system.
在来自两个不同地点的61名患者的验证人群中，使用两种不同的相机/计算机系统，评估了为期2天的负荷/静息定量锝-99m（Tc-99m）甲氧基异丁基异腈（Tc- sestamibi）单光子发射计算机断层扫描（SPECT）的临床诊断准确性。研究人群包括53名接受导管检查的患者，其中29名来自雪松西奈医疗中心（CSMC），24名来自德克萨斯大学西南医学中心（UTSMC），以及8名UTSMC患者，其冠状动脉疾病的预测试可能性小于5%。解释采用了在CSMC另外15名男性和8名女性中制定的性别特异性正常范围，这些人患严重冠状动脉疾病的可能性小于5%。CSMC的结果与UTSMC的结果没有差异。检测冠状动脉疾病（狭窄大于或等于50%）患者的总体敏感性为94%（CSMC：92%，UTSMC：95%）。5名冠状动脉造影正常的患者的总体特异性为80%（CSMC：67%，UTSMC：100%）。冠状动脉疾病可能性低的患者的正常率为88%。血管敏感性为85%（CSMC：84%，UTSMC：85%），而血管特异性为71%（CSMC：72%，UTSMC：69%）。男性和女性人群之间的敏感性和特异性也没有显著差异。此外，在评估疾病范围（正常冠状动脉造影、单支或多支血管疾病）方面，与冠状动脉造影的一致性为75%（kappa = 0.6 +/- 0.1）。这项研究表明，通过定量分析的Tc- sestamibi SPECT对于冠状动脉疾病的检测和定位是准确的。此外，当将CSMC定量方法应用于使用不同相机/计算机系统在不同地点获取的数据时，显示出相似的诊断准确性。
