Ben-Haim Simona, Almukhailed Omar, Neill Johanne, Slomka Piotr, Allie Rayjanah, Shiti Dalia, Berman Daniel S, Bomanji Jamshed
Institute of Nuclear Medicine, University College London Hospitals, NHS Trust, London, UK,
J Nucl Cardiol. 2014 Jun;21(3):478-85. doi: 10.1007/s12350-014-9853-0. Epub 2014 Jan 30.
We have assessed whether additional upright imaging increases the confidence of interpretation of stress only supine myocardial perfusion imaging (MPI) in obese patients.
Tc-MIBI stress MPI of 101 consecutive patients (M = 49, 62 ± 12 years) with BMI ≥30 scanned on the D-SPECT cardiac camera were assessed. Images were interpreted as diagnostic or equivocal and the need for a rest study was recorded. Stress supine MPI was interpreted first, then gated and finally upright data were added. Defects on supine but not on upright were defined as artefacts and defects seen on both as abnormal. The total perfusion deficit (TPD) was also quantified. There were 27 normal, 22 abnormal, and 52 equivocal supine scans. The median EF was 52%, unaffecting the need for rest imaging. Upright imaging reclassified 32/52 (62%) equivocal studies as normal and 6/52 (11%) as abnormal (P < 0.001). Rest scan was deemed needed in 74/101 patients on supine vs 42/101 on supine/upright (P < 0.001). Supine TPD was normal in 53 and supine/upright TPD was normal in 70 patients (P < 0.001).
Supine stress MPI is inadequate in obese patients. The addition of upright imaging significantly increases the ability to interpret scans as diagnostic and may reduce considerably the need for rest imaging.
我们评估了在肥胖患者中，额外的直立位成像是否能提高仅进行仰卧位心肌灌注成像（MPI）时的解读信心。
对101例连续的BMI≥30的患者（男性49例，年龄62±12岁）进行了锝-甲氧基异丁基异腈（Tc-MIBI）负荷MPI检查，使用D-SPECT心脏相机进行扫描。图像被解读为诊断性或可疑性，并记录是否需要进行静息检查。首先解读仰卧位负荷MPI图像，然后进行门控，最后添加直立位数据。仰卧位出现但直立位未出现的缺损定义为伪影，两者均出现的缺损定义为异常。还对总灌注缺损（TPD）进行了量化分析。仰卧位扫描结果为27例正常、22例异常和52例可疑。中位数射血分数（EF）为52%，不影响是否需要进行静息成像。直立位成像将52例可疑研究中的32例（62%）重新分类为正常，6例（11%）重新分类为异常（P<0.001）。仰卧位时101例患者中有74例被认为需要进行静息扫描，仰卧位/直立位联合检查时为42例（P<0.001）。53例患者仰卧位TPD正常，70例患者仰卧位/直立位联合检查TPD正常（P<0.001）。
肥胖患者仰卧位负荷MPI检查不充分。添加直立位成像显著提高了将扫描解读为诊断性的能力，并可能大幅减少静息成像的需求。
