Division of Cardiology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
Ann Nucl Med. 2020 Sep;34(9):682-690. doi: 10.1007/s12149-020-01493-4. Epub 2020 Jun 30.
We introduced a method to measure the extent of myocardial ischemia and steal with SPECT MBF quantitation.
Eighty-seven patients who received rest/Dipyridamole-stress Tc-Sestamibi (MIBI) dynamic SPECT scans and coronary angiography were included. Dynamic SPECT images were reconstructed with full physical corrections. The one-tissue kinetic model was utilized to quantify K1 and further converted to MBF with required corrections. Rest MBF, stress MBF and myocardial flow reserve (MFR) were converted to a flow status polar map by a flow diagram. Extents of 7 flow statuses were verified their cutoff points for detecting stenoses. The diagnostic performance (DP) was compared to that of MFR.
Cutoff point of the extent to detect ≥ 50% stenosis was 3.01% for ischemia-steal status and 20.3% for the combined status of ischemia-steal and moderate. Using these criteria, sensitivity, specificity and accuracy to detect ≥ 50% stenosis were (80%, 75%, 79%) and (86%, 68%, 80%) for ≥ 70% stenosis. The DP was superior to that of MFR < 2.0 criterion (≥ 50%: 70%, 63%, 69%; ≥ 70%: 73%, 61%, 69%) (all p < 0.015).
SPECT MBF quantitation integrated with the flow diagram can measure the extent of myocardial ischemia and steal which appeared more accurate to detect angiographic stenoses than the single MFR parameter.
我们引入了一种通过 SPECT MBF 定量测量心肌缺血和盗血程度的方法。
本研究纳入了 87 例行静息/双嘧达莫负荷铊-甲氧基异丁基异腈（MIBI）动态 SPECT 扫描和冠状动脉造影的患者。使用全物理校正方法重建动态 SPECT 图像。采用单组织动力学模型来量化 K1，并进一步进行所需校正以转换为 MBF。通过血流图将静息 MBF、应激 MBF 和心肌血流储备（MFR）转换为血流状态极坐标图。验证了 7 种血流状态的程度以检测狭窄的截断值。并将诊断性能（DP）与 MFR 进行比较。
检测 ≥ 50%狭窄的缺血-盗血状态和缺血-盗血合并中度狭窄状态的程度截断值分别为 3.01%和 20.3%。使用这些标准，检测 ≥ 50%狭窄的灵敏度、特异性和准确性分别为（80%、75%、79%）和（86%、68%、80%），检测 ≥ 70%狭窄的灵敏度、特异性和准确性分别为（73%、61%、69%）和（73%、61%、69%）。DP 优于 MFR < 2.0 标准（≥ 50%：70%、63%、69%；≥ 70%：73%、61%、69%）（均 p < 0.015）。
SPECT MBF 定量与血流图相结合可以测量心肌缺血和盗血的程度，与单一的 MFR 参数相比，该方法检测血管造影狭窄更准确。
