在大型人群中，比较心肌灌注 SPECT 检测冠状动脉疾病的全自动计算机分析与视觉评分。
Comparison of fully automated computer analysis and visual scoring for detection of coronary artery disease from myocardial perfusion SPECT in a large population.
机构信息
Departments of Imaging and Medicine and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
出版信息
J Nucl Med. 2013 Feb;54(2):221-8. doi: 10.2967/jnumed.112.108969. Epub 2013 Jan 11.
UNLABELLED
We compared the performance of fully automated quantification of attenuation-corrected (AC) and noncorrected (NC) myocardial perfusion SPECT (MPS) with the corresponding performance of experienced readers for detection of coronary artery disease (CAD).
METHODS
Rest-stress (99m)Tc-sestamibi MPS studies (n = 995; 650 consecutive cases with coronary angiography and 345 with likelihood of CAD < 5%) were obtained by MPS with AC. The total perfusion deficit (TPD) for AC and NC data was compared with the visual summed stress and rest scores of 2 experienced readers. Visual reads were performed in 4 consecutive steps with the following information progressively revealed: NC data, AC + NC data, computer results, and all clinical information.
RESULTS
The diagnostic accuracy of TPD for detection of CAD was similar to both readers (NC: 82% vs. 84%; AC: 86% vs. 85%-87%; P = not significant) with the exception of the second reader when clinical information was used (89%, P < 0.05). The receiver-operating-characteristic area under the curve (ROC AUC) for TPD was significantly better than visual reads for NC (0.91 vs. 0.87 and 0.89, P < 0.01) and AC (0.92 vs. 0.90, P < 0.01), and it was comparable to visual reads incorporating all clinical information. The per-vessel accuracy of TPD was superior to one reader for NC (81% vs. 77%, P < 0.05) and AC (83% vs. 78%, P < 0.05) and equivalent to the second reader (NC, 79%; and AC, 81%). The per-vessel ROC AUC for NC (0.83) and AC (0.84) for TPD was better than that for the first reader (0.78-0.80, P < 0.01) and comparable to that of the second reader (0.82-0.84, P = not significant) for all steps.
CONCLUSION
For detection of ≥70% stenoses based on angiographic criteria, a fully automated computer analysis of NC and AC MPS data is equivalent for per-patient and can be superior for per-vessel analysis, when compared with expert analysis.
目的
比较全自动定量分析衰减校正（AC）和非校正（NC）心肌灌注 SPECT（MPS）与有经验的读者在检测冠状动脉疾病（CAD）方面的性能。
方法
对 995 例静息-应激（99m）Tc-替替比碇 MPS 研究（650 例连续冠状动脉造影和 345 例 CAD 可能性<5%）进行 MPS 检查，采用 AC 获得总灌注缺损（TPD）。比较 AC 和 NC 数据的视觉总和应激和休息评分与 2 名有经验的读者。在 4 个连续步骤中进行视觉读取，逐步揭示以下信息：NC 数据、AC+NC 数据、计算机结果和所有临床信息。
结果
TPD 对 CAD 的诊断准确性与两位读者相似（NC：82%与 84%；AC：86%与 85%-87%；P=无显著差异），但当使用临床信息时，第二位读者除外（89%，P<0.05）。AC 时，TPD 的接收者操作特征曲线下面积（ROC AUC）明显优于 NC 时的视觉读数（0.91 与 0.87 和 0.89，P<0.01），与纳入所有临床信息的视觉读数相当。与 NC（81%与 77%，P<0.05）和 AC（83%与 78%，P<0.05）的一位读者相比，TPD 的单支血管准确性更高，与第二位读者相当（NC，79%；AC，81%）。NC（0.83）和 AC（0.84）时 TPD 的单支血管 ROC AUC 优于第一位读者（0.78-0.80，P<0.01），与第二位读者相当（0.82-0.84，P=无显著差异）。
结论
基于血管造影标准，检测≥70%狭窄时，与专家分析相比，NC 和 AC MPS 数据的全自动计算机分析在患者个体水平上是等效的，在血管水平上可以更优。
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