应用常规 SPECT 相机对有挑战性患者行 Tc 快速心肌灌注显像。
Fast myocardial perfusion imaging with Tc in challenging patients using conventional SPECT cameras.
机构信息
Nuclear Medicine Department, Onassis Cardiac Surgery Center, Zoodochou Pigis 54, Melissia, ZC 15127, Athens, Greece.
Medical Physics Department, Athens Medical University, Athens, Greece.
出版信息
J Nucl Cardiol. 2017 Aug;24(4):1314-1327. doi: 10.1007/s12350-016-0431-5. Epub 2016 Mar 14.
BACKGROUND
We attempted to validate the performance of a fast myocardial perfusion imaging (MPI) protocol in diagnostically challenging patients.
METHODS
78 patients with ΒΜΙ > 24.9, LVH or three vessels disease underwent two sequential gated-MPI studies. The first at 15 (Early Imaging, EI) and the second at 45 (Late Imaging, LI) minutes post Tc-injection, at both stress and rest. Counts over heart (H), liver (Liv) and subdiaphragmatic space (Sub) and image quality, and myocardial perfusion and function parameters were compared between the two protocols. Coronary angiography was performed within 2 months from MPI, and ROC analysis was used to compare the diagnostic accuracy for the detection of ≥50% diameter luminal stenosis.
RESULTS
Quality was optimal-good in 93% of EI and 98% of LI studies (P = .12), H/Liv and stress H/Sub ratios were similar, but rest H/Sub ratio was lower in EI (P = .009). SSS [10 (0 to 46) vs 9 (0 to 36), P = .006] and SDS [3 (0 to 35) vs 2 (0 to 34), P = .02] were higher in EI protocol. LVEF, motion and thickening scores did not differ between the two protocols. A highly significant (P < .001) linear relationship with clinically negligible mean differences in Bland-Altman analysis was observed for all perfusion and function-related data. Sensitivity (EI 81%, LI 80%) and specificity (65% for both) did not differ (P = .23) between the two protocols.
CONCLUSION
The fast protocol is technically feasible and diagnostically accurate compared to the established protocol in diagnostically challenging patients.
背景
我们试图验证一种快速心肌灌注成像（MPI）方案在诊断挑战性患者中的性能。
方法
78 名 BMI>24.9、LVH 或三支血管疾病患者接受了两次连续门控-MPI 研究。第一次在注射 Tc 后 15 分钟（早期成像，EI），第二次在 45 分钟（晚期成像，LI），均在应激和休息时进行。比较两种方案之间的心脏（H）、肝脏（Liv）和膈下空间（Sub）计数以及图像质量和心肌灌注及功能参数。MPI 后 2 个月内进行冠状动脉造影，使用 ROC 分析比较两种方案检测≥50%直径管腔狭窄的诊断准确性。
结果
EI 研究中 93%和 LI 研究中 98%的质量为最佳-良好（P=.12），H/Liv 和应激 H/Sub 比值相似，但 EI 中的静息 H/Sub 比值较低（P=.009）。SSS[10（0 至 46）比 9（0 至 36），P=.006]和 SDS[3（0 至 35）比 2（0 至 34），P=.02]在 EI 方案中较高。两种方案的 LVEF、运动和增厚评分无差异。Bland-Altman 分析显示，所有灌注和功能相关数据均具有高度显著（P<.001）的线性关系，平均差异具有临床可忽略性。两种方案的敏感性（EI 81%，LI 80%）和特异性（均为 65%）无差异（P=.23）。
结论
与既定方案相比，快速方案在诊断挑战性患者中具有技术可行性和诊断准确性。
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