对比疑似冠心病女性患者的心血管磁共振和单光子发射计算机断层扫描：来自临床评估磁共振成像在冠心病中的应用（CE-MARC）试验。
Comparison of cardiovascular magnetic resonance and single-photon emission computed tomography in women with suspected coronary artery disease from the Clinical Evaluation of Magnetic Resonance Imaging in Coronary Heart Disease (CE-MARC) Trial.
机构信息
Multidisciplinary Cardiovascular Research Centre and Division of Cardiovascular and Diabetes Research, Leeds Institute of Genetics, Health & Therapeutics (J.P.G., M.M., N.M., P.B., S.G.B., S.P.) and Clinical Trials Research Unit (J.M.B., C.C.E., J.N.), University of Leeds, Leeds, UK; and Department of Nuclear Cardiology, Leeds General Infirmary, Leeds, UK (C.J.D.).
出版信息
Circulation. 2014 Mar 11;129(10):1129-38. doi: 10.1161/CIRCULATIONAHA.112.000071. Epub 2013 Dec 19.
BACKGROUND
Coronary artery disease is the leading cause of death in women, and underdiagnosis contributes to the high mortality. This study compared the sex-specific diagnostic performance of cardiovascular magnetic resonance (CMR) and single-photon emission computed tomography (SPECT).
METHODS AND RESULTS
A total of 235 women and 393 men with suspected angina underwent CMR, SPECT, and x-ray angiography as part of the Clinical Evaluation of Magnetic Resonance Imaging in Coronary Heart Disease (CE-MARC) study. CMR comprised adenosine stress/rest perfusion, cine imaging, late gadolinium enhancement, and magnetic resonance coronary angiography. Gated adenosine stress/rest SPECT was performed with (99m)Tc-tetrofosmin. For CMR, the sensitivity in women and men was similar (88.7% versus 85.6%; P=0.57), as was the specificity (83.5% versus 82.8%; P=0.86). For SPECT, the sensitivity was significantly worse in women than in men (50.9% versus 70.8%; P=0.007), but the specificities were similar (84.1% versus 81.3%; P=0.48). The sensitivity in both the female and male groups was significantly higher with CMR than SPECT (P<0.0001 for both), but the specificity was similar (P=0.77 and P=1.00, respectively). For perfusion-only components, CMR outperformed SPECT in women (area under the curve, 0.90 versus 0.67; P<0.0001) and in men (area under the curve, 0.89 versus 0.74; P<0.0001). Diagnostic accuracy was similar in both sexes with perfusion CMR (P=1.00) but was significantly worse in women with SPECT (P<0.0001).
CONCLUSIONS
In both sexes, CMR has greater sensitivity than SPECT. Unlike SPECT, there are no significant sex differences in the diagnostic performance of CMR. These findings, plus an absence of ionizing radiation exposure, mean that CMR should be more widely adopted in women with suspected coronary artery disease.
CLINICAL TRIAL REGISTRATION URL
http://www.controlled-trials.com. Unique identifier: ISRCTN77246133.
背景
冠心病是女性死亡的主要原因，而诊断不足是导致高死亡率的原因之一。本研究比较了心血管磁共振（CMR）和单光子发射计算机断层扫描（SPECT）在女性中的诊断性能。
方法和结果
共 235 名疑似心绞痛的女性和 393 名男性患者参与了临床评价磁共振成像在冠心病中的应用（CE-MARC）研究，该研究将 CMR、SPECT 和 X 射线血管造影作为检查手段。CMR 包括腺苷负荷/静息灌注、电影成像、晚期钆增强和磁共振冠状动脉造影。门控腺苷负荷/静息 SPECT 使用（99m）Tc-四氮茂。对于 CMR，女性和男性的敏感性相似（88.7%比 85.6%；P=0.57），特异性也相似（83.5%比 82.8%；P=0.86）。对于 SPECT，女性的敏感性明显低于男性（50.9%比 70.8%；P=0.007），但特异性相似（84.1%比 81.3%；P=0.48）。在女性和男性组中，CMR 的敏感性均明显高于 SPECT（P<0.0001），但特异性相似（P=0.77 和 P=1.00）。对于灌注成像，CMR 优于 SPECT，在女性（曲线下面积 0.90 比 0.67；P<0.0001）和男性（曲线下面积 0.89 比 0.74；P<0.0001）中均如此。在女性和男性中，灌注 CMR 的诊断准确性相似（P=1.00），但 SPECT 的准确性在女性中明显较差（P<0.0001）。
结论
在女性和男性中，CMR 的敏感性均高于 SPECT。与 SPECT 不同，CMR 的诊断性能在两性之间没有显著差异。这些发现以及不存在电离辐射暴露，意味着 CMR 应更广泛地应用于疑似冠心病的女性患者。
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