Taasan Vicente, Wokhlu Anita, Taasan Michael V, Dusaj Raman S, Mehta Ajay, Kraft Steven, Winchester David, Wymer David
Malcom Randall VA Medical Center, 1600 SW Archer Road, Gainesville, FL, 32606, USA.
Lake City VA Medical Center, Lake City, FL, USA.
J Nucl Cardiol. 2016 Dec;23(6):1470-1476. doi: 10.1007/s12350-015-0358-2. Epub 2015 Dec 30.
Combined supine-prone myocardial perfusion imaging (CSP MPI) has been shown to reduce attenuation artifact in comparison to supine-only (SU) MPI in mixed-gender populations with varying risk for coronary artery disease (CAD), often where patients served as their own controls. However, there is limited direct comparison of these imaging strategies in men.
934 male patients underwent CSP or SU MPI. Diagnostic certainty of interpretation was compared. Within the cohort, 116 were referred for left heart catheterization (LHC) to assess for CAD. Sensitivity, specificity, and area under the curve (AUC) were compared with additional analysis based on body mass index (BMI).
597 patients completed the SU protocol and 337 patients completed the CSP protocol. Equivocal studies were seen more frequently in the SU group (13%) than in the CSP group (4%, P < .001). At catheterization, the specificity for CSP MPI of 70% was higher than 40% for SU MPI (P = .032). The CSP AUC (0.80 ± 0.06) was significantly larger than SU AUC (0.57 ± 0.05, P = .004). CSP specificity was significantly higher in obese patients.
CSP MPI increases diagnostic certainty and improves test accuracy for CAD detection in men with CAD risk factors, especially obese patients, compared to SU MPI.
与仅采用仰卧位（SU）的心肌灌注成像相比，仰卧-俯卧联合心肌灌注成像（CSP MPI）已被证明能减少不同性别、患冠状动脉疾病（CAD）风险各异的人群中的衰减伪影，这类研究通常以患者自身作为对照。然而，在男性中对这些成像策略进行的直接比较有限。
934例男性患者接受了CSP或SU MPI检查。比较解释的诊断确定性。在该队列中，116例患者被转诊进行左心导管检查（LHC）以评估CAD。比较敏感性、特异性和曲线下面积（AUC），并根据体重指数（BMI）进行额外分析。
597例患者完成了SU方案，337例患者完成了CSP方案。SU组（13%）出现模棱两可研究结果的频率高于CSP组（4%，P <.001）。在导管检查时，CSP MPI的特异性为70%，高于SU MPI的40%（P = 0.032）。CSP的AUC（0.80±0.06）显著大于SU的AUC（0.57±0.05，P = 0.004）。肥胖患者中CSP的特异性显著更高。
与SU MPI相比，CSP MPI提高了诊断确定性，并改善了对有CAD风险因素男性（尤其是肥胖患者）CAD检测的测试准确性。
