Maddahi J, Van Train K, Prigent F, Garcia E V, Friedman J, Ostrzega E, Berman D
Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California.
J Am Coll Cardiol. 1989 Dec;14(7):1689-99. doi: 10.1016/0735-1097(89)90017-x.
One hundred eight-three men underwent stress-redistribution thallium-201 myocardial perfusion tomography. After evaluation of various preprocessing filters in a phantom study, the Butterworth filter with a frequency cutoff of 0.2 cycles/pixel, order 5 (which provided optimal filter power) was used in the back projection algorithm of the patient studies. All short-axis and apical portions of vertical long-axis images were quantified by dividing each myocardial slice into 60 equal sectors and displaying the maximal count per sector as a linear profile. In a pilot group consisting of 20 normal men (less than 5% likelihood of coronary artery disease) and 25 men with coronary artery disease (greater than or equal to 50% coronary stenosis by angiography), profiles representing the lowest observed value below the mean normal profiles provided the best threshold for defining normal limits. Abnormal portions of the patient profiles were plotted on a two-dimensional polar map. The polar map was divided into 102 sectors, and sectors with a probability of greater than or equal to 80% for disease of each one of the three major coronary arteries were clustered to represent specific coronary artery territories. Receiver operating characteristic curve analysis for defect size showed that the optimal threshold for defining a definite perfusion defect was 12% for the left anterior descending and left circumflex and 8% for the right coronary artery territories. These criteria were prospectively applied to an additional 92 patients with angiographic coronary artery disease, 18 patients with normal coronary arteriograms and 28 patients with less than 5% likelihood of coronary disease. Sensitivity, specificity (in patients with normal coronary arteriograms) and normalcy rate (in patients with less than 5% likelihood of coronary artery disease) for overall detection of coronary disease were 96%, 56% and 86%, respectively. Sensitivity and specificity for identification of individual diseased vessels were, respectively, 78% and 85% for the left anterior descending, 79% and 60% for the left circumflex and 81% and 71% for the right coronary artery. These results were not significantly different from those of the pilot group. An optimized quantitative method for interpretation of stress thallium-201 myocardial perfusion tomography has been developed. Prospective application of this method indicates that the technique is accurate for the overall detection of coronary artery disease and identification of disease in individual arteries.
183名男性接受了静息-再分布铊-201心肌灌注断层扫描。在对模型研究中的各种预处理滤波器进行评估后，在患者研究的反投影算法中使用了截止频率为0.2周期/像素、阶数为5（可提供最佳滤波功率）的巴特沃斯滤波器。垂直长轴图像的所有短轴和心尖部分通过将每个心肌切片分成60个相等的扇区并将每个扇区的最大计数显示为线性轮廓来进行量化。在一个由20名正常男性（冠状动脉疾病可能性小于5%）和25名患有冠状动脉疾病（血管造影显示冠状动脉狭窄大于或等于50%）组成的试验组中，代表低于正常平均轮廓的最低观测值的轮廓提供了定义正常范围的最佳阈值。将患者轮廓的异常部分绘制在二维极坐标图上。极坐标图被分成102个扇区，三个主要冠状动脉中每一支疾病发生概率大于或等于80%的扇区被聚类以代表特定的冠状动脉区域。对缺损大小的受试者操作特征曲线分析表明，定义明确灌注缺损的最佳阈值，左前降支和左旋支为12%，右冠状动脉区域为8%。这些标准被前瞻性地应用于另外92例血管造影确诊为冠状动脉疾病的患者、18例冠状动脉造影正常的患者以及28例冠状动脉疾病可能性小于5%的患者。总体检测冠状动脉疾病的敏感性、特异性（冠状动脉造影正常的患者）和正常率（冠状动脉疾病可能性小于5%的患者）分别为96%、56%和86%。识别单个病变血管的敏感性和特异性，左前降支分别为78%和85%，左旋支分别为79%和60%，右冠状动脉分别为81%和71%。这些结果与试验组的结果无显著差异。已经开发出一种优化的定量方法用于解释静息铊-201心肌灌注断层扫描。该方法的前瞻性应用表明，该技术在总体检测冠状动脉疾病和识别单个动脉疾病方面是准确的。
