Shiraishi Shinya, Sakamoto Fumi, Tsuda Noriko, Yoshida Morikatsu, Tomiguchi Seiji, Utsunomiya Daisuke, Ogawa Hisao, Yamashita Yasuyuki
Department of Diagnostic Radiology, Graduate School of Life Sciences, Kumamoto University.
Circ J. 2015;79(3):623-31. doi: 10.1253/circj.CJ-14-0932. Epub 2015 Jan 14.
Myocardial perfusion imaging (MPI) may fail to detect balanced ischemia. We evaluated myocardial perfusion reserve (MPR) using Tl dynamic single-photon emission computed tomography (SPECT) and a novel cadmium zinc telluride (CZT) camera for predicting 3-vessel or left main coronary artery disease (CAD). METHODS AND RESULTS: A total of 55 consecutive patients with suspected CAD underwent SPECT-MPI and coronary angiography. The MPR index was calculated using the standard 2-compartment kinetic model. We analyzed the utility of MPR index, other SPECT findings, and various clinical variables. On multivariate analysis, MPR index and history of previous myocardial infarction (MI) predicted left main and 3-vessel disease. The area under the receiver operating characteristic curve was 0.81 for MPR index, 0.699 for history of previous MI, and 0.86 for MPR index plus history of previous MI. MPR index ≤1.5 yielded the highest diagnostic accuracy. Sensitivity, specificity, and accuracy were 86%, 78%, and 80%, respectively, for MPR index, 64%, 76%, 73% for previous MI, and 57%, 93%, and 84% for MPR index plus history of previous MI.
Quantification of MPR using dynamic SPECT and a novel CZT camera may identify balanced ischemia in patients with left main or 3-vessel disease.
心肌灌注成像（MPI）可能无法检测到均衡性缺血。我们使用铊动态单光子发射计算机断层扫描（SPECT）和一种新型碲化镉锌（CZT）相机评估心肌灌注储备（MPR），以预测三支血管或左主干冠状动脉疾病（CAD）。
连续55例疑似CAD患者接受了SPECT-MPI和冠状动脉造影。使用标准的双室动力学模型计算MPR指数。我们分析了MPR指数、其他SPECT检查结果及各种临床变量的效用。多因素分析显示，MPR指数和既往心肌梗死（MI）病史可预测左主干和三支血管病变。MPR指数的受试者操作特征曲线下面积为0.81，既往MI病史为0.699，MPR指数加既往MI病史为0.86。MPR指数≤1.5时诊断准确性最高。MPR指数的敏感性、特异性和准确性分别为86%、78%和80%，既往MI为64%、76%、73%，MPR指数加既往MI病史为57%、93%和84%。
使用动态SPECT和新型CZT相机对MPR进行定量分析，可能识别出左主干或三支血管病变患者的均衡性缺血。
