Mount Sinai Division of Cardiology (Mount Sinai Heart), Mount Sinai Medical Center, P.O. Box 1030, One Gustave L Levy Place, New York, NY, 10029, USA,
J Nucl Cardiol. 2013 Oct;20(5):763-73. doi: 10.1007/s12350-013-9735-x. Epub 2013 Jun 5.
Recently introduced high-efficiency (HE) SPECT cameras with solid-state CZT detectors have been shown to decrease imaging time and reduce radiation exposure to patients. An automated, computer-derived quantification of HE MPI has been shown to correlate well with coronary angiography on one HE SPECT camera system (D-SPECT), but has not been compared to visual interpretation on any of the HE SPECT platforms.
Patients undergoing a clinically indicated Tc-99m sestamibi HE SPECT (GE Discovery 530c with supine and prone imaging) study over a 1-year period followed by a coronary angiogram within 2 months were included. Only patients with a history of CABG surgery were excluded. Both MPI studies and coronary angiograms were reinterpreted by blinded readers. One hundred and twenty two very low (risk of CAD < 5%) or low (risk of CAD < 10%) likelihood subjects with normal myocardial perfusion were used to create normal reference limits. Computer-derived quantification of the total perfusion deficit at stress and rest was obtained with QPS software. The visual and automated MPI quantification were compared to coronary angiography (≥70% luminal stenosis) by receiver operating curve (ROC) analysis.
Of the 3,111 patients who underwent HE SPECT over a 1-year period, 160 patients qualified for the correlation study (66% male, 52% with a history of CAD). The ROC area under the curve (AUC) was similar for both the automated and the visual interpretations using both supine only and combined supine and prone images (0.69-0.74). Using thresholds determined from sensitivity and specificity curves, the automated reads showed higher specificity (59%-67% vs 27%-60%) and lower sensitivity (71%-72% vs 79%-93%) than the visual reads. By including prone images sensitivity decreased slightly but specificity increased for both. By excluding patients with known CAD and cardiomyopathies, AUC and specificity increased for both techniques (0.72-0.82). The use of a difference score to evaluate ischemic burden resulted in lower sensitivities but higher specificities for both automated and visual quantification. There was good agreement between the visual interpretation and automated quantification in the entire cohort of 160 unselected consecutive patients (r = 0.70-0.81, P < .0001).
Automated and visual quantification of high-efficiency SPECT MPI with the GE Discovery camera provides similar overall diagnostic accuracy when compared to coronary angiography. There was good correlation between the two methods of assessment. Combined supine and prone stress imaging provided the best diagnostic accuracy.
最近推出的具有固态 CZT 探测器的高效 (HE) SPECT 相机已被证明可以缩短成像时间并降低患者的辐射暴露。一种自动的、计算机衍生的 HE MPI 定量分析已被证明与一种 HE SPECT 系统（D-SPECT）上的冠状动脉造影有很好的相关性，但尚未与任何 HE SPECT 平台上的视觉解释进行比较。
在一年期间，对接受临床指征 Tc-99m sestamibi HE SPECT（GE Discovery 530c 仰卧和俯卧成像）研究的患者进行研究，并在 2 个月内进行冠状动脉造影。仅排除有 CABG 手术史的患者。MPI 研究和冠状动脉造影均由盲法读者重新解读。使用 122 名非常低（CAD 风险<5%）或低（CAD 风险<10%）可能性且心肌灌注正常的患者创建正常参考限值。使用 QPS 软件获得应激和休息时总灌注缺陷的计算机衍生定量。通过接收者操作曲线 (ROC) 分析比较视觉和自动 MPI 定量与冠状动脉造影（≥70% 管腔狭窄）。
在一年期间进行 HE SPECT 的 3111 名患者中，有 160 名患者符合相关性研究的条件（66%为男性，52%有 CAD 病史）。使用仅仰卧位和仰卧位和俯卧位组合图像的自动和视觉解释的 ROC 曲线下面积（AUC）相似（0.69-0.74）。使用来自灵敏度和特异性曲线的阈值，自动读取显示出更高的特异性（59%-67%比 27%-60%）和更低的灵敏度（71%-72%比 79%-93%）比视觉读取。通过包含俯卧位图像，两种方法的敏感性略有降低，但特异性均增加。排除已知 CAD 和心肌病的患者后，两种技术的 AUC 和特异性均增加（0.72-0.82）。使用差异评分评估缺血负担会导致自动和视觉定量的灵敏度降低，但特异性增加。在 160 名未经选择的连续患者的整个队列中，视觉解释和自动定量之间有很好的一致性（r=0.70-0.81，P<.0001）。
与冠状动脉造影相比，GE Discovery 相机的高效 SPECT MPI 的自动和视觉定量提供了相似的整体诊断准确性。两种评估方法之间存在良好的相关性。仰卧位和俯卧位联合应激成像提供了最佳的诊断准确性。
