Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
Eur J Nucl Med Mol Imaging. 2012 Oct;39(10):1599-608. doi: 10.1007/s00259-012-2180-2. Epub 2012 Jul 13.
Despite its high prognostic value, widespread clinical implementation of (123)I-meta-iodobenzylguanidine (MIBG) myocardial scintigraphy is hampered by a lack of validation and standardization. The purpose of this study was to assess the reliability of planar (123)I-MIBG myocardial scintigraphy in patients with heart failure (HF).
Planar myocardial MIBG images of 70 HF patients were analysed by two experienced and one inexperienced observer. The reproducibility of early and delayed heart-to-mediastinum (H/M) ratios, as well as washout rate (WR) calculated by two different methods, was assessed using the intraclass correlation coefficient (ICC) and the Bland-Altman analysis. In addition, a subanalysis in patients with a very low H/M ratio (delayed H/M ratio <1.4) was performed. The delayed H/M ratio was also assessed using fixed-size oval and circular cardiac regions of interest (ROI).
Intra- and interobserver analyses and experienced versus inexperienced observer analysis showed excellent agreement for the measured early and delayed H/M ratios and WR on planar (123)I-MIBG images (the ICCs for the delayed H/M ratios were 0.98, 0.96 and 0.90, respectively). In addition, the WR without background correction resulted in higher reliability than the WR with background correction (the interobserver Bland-Altman 95 % limits of agreement were -2.50 to 2.16 and -10.10 to 10.14, respectively). Furthermore, the delayed H/M ratio measurements remained reliable in a subgroup of patients with a very low delayed H/M ratio (ICC 0.93 for the inter-observer analysis). Moreover, a fixed-size cardiac ROI could be used for the assessment of delayed H/M ratios, with good reliability of the measurement.
The present study showed a high reliability of planar (123)I-MIBG myocardial scintigraphy in HF patients, confirming that MIBG myocardial scintigraphy can be implemented easily for clinical risk stratification in HF.
尽管碘[123I]间位碘苄胍（MIBG）心肌闪烁显像具有很高的预后价值，但由于缺乏验证和标准化，其在临床上的广泛应用受到了阻碍。本研究旨在评估平面[123I] -MIBG 心肌闪烁显像在心力衰竭（HF）患者中的可靠性。
对 70 例 HF 患者的平面心肌 MIBG 图像进行了两位有经验和一位无经验的观察者分析。使用组内相关系数（ICC）和 Bland-Altman 分析评估两种不同方法计算的早期和延迟心脏与纵隔（H/M）比值以及洗脱率（WR）的可重复性。此外，对 H/M 比值非常低（延迟 H/M 比值<1.4）的患者进行了亚组分析。还使用固定大小的椭圆形和圆形心脏感兴趣区（ROI）评估了延迟 H/M 比值。
观察者内和观察者间分析以及有经验与无经验观察者分析均显示，平面[123I] -MIBG 图像上测量的早期和延迟 H/M 比值和 WR 的一致性非常好（延迟 H/M 比值的 ICC 分别为 0.98、0.96 和 0.90）。此外，不进行背景校正的 WR 比进行背景校正的 WR 更可靠（观察者间 Bland-Altman 95%置信区间分别为-2.50 至 2.16 和-10.10 至 10.14）。此外，在 H/M 比值非常低的亚组患者中，延迟 H/M 比值的测量仍然可靠（观察者间分析的 ICC 为 0.93）。此外，还可以使用固定大小的心脏 ROI 评估延迟 H/M 比值，测量具有良好的可靠性。
本研究表明，HF 患者的平面[123I] -MIBG 心肌闪烁显像具有很高的可靠性，证实 MIBG 心肌闪烁显像可方便地用于 HF 的临床危险分层。
