Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati College of Medicine, 231 Albert B. Sabin Way ML 0542, Cincinnati, OH, 45267-0542, USA.
Division of Biostatistics and Epidemiology, Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA.
J Nucl Cardiol. 2021 Aug;28(4):1569-1582. doi: 10.1007/s12350-019-01878-7. Epub 2019 Sep 5.
Limited data address the roles of gender, perfusion defect reversibility, and imaging position in interpretation of images acquired on an upright/supine cadmium-zinc-telluride (CZT) cardiac imaging system.
From a consecutive cohort of patients imaged on an upright/supine CZT camera, 260 patients with coronary angiograms were studied. Multivariable models identified gender as a significant effect modifier for imaging variables of CAD. For males, a supine summed stress score (SSS) ≥ 3 provided high accuracy (sensitivity 70.7%, specificity 72.2%), and highest contribution to multivariable models. In females, supine SSS ≥ 2 provided the best cut-off for defect size and severity (sensitivity 90%, specificity 35.9%), but specificity was improved substantially to 53.3% with decrease in sensitivity to 80% by also requiring quantitative identification of perfusion defect reversibility in the supine position. Eight variables, accurate for predicting coronary disease, were more accurate with supine than upright imaging.
Perfusion defect reversibility improved specificity in female patients for detection of coronary disease compared to perfusion defect size and extent alone. Supine images provided superior accuracy for detection of coronary disease compared to upright images.
关于性别、灌注缺损可逆性以及在直立/仰卧位下使用碲锌镉（CZT）心脏成像系统获取的图像解读中的成像位置的作用，目前仅有有限的数据。
本研究纳入了连续入组的在直立/仰卧位 CZT 相机上进行成像的患者，其中 260 例患者进行了冠状动脉造影检查。多变量模型确定了性别是 CAD 成像变量的显著效应修饰因子。对于男性，仰卧位总和应激评分（SSS）≥3 具有较高的准确性（敏感性 70.7%，特异性 72.2%），对多变量模型的贡献最大。对于女性，仰卧位 SSS≥2 是最佳的缺陷大小和严重程度的截断值（敏感性 90%，特异性 35.9%），但通过还需要在仰卧位定量识别灌注缺损的可逆性，特异性可提高到 53.3%，同时敏感性降低至 80%。8 个用于预测冠心病的变量，仰卧位比直立位成像更准确。
与灌注缺损大小和范围相比，灌注缺损可逆性可提高女性患者对冠心病的检测特异性。与直立位图像相比，仰卧位图像对冠心病的检测更准确。
