Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
Department of Radiology and Imaging Sciences, Emory University Hospital, Emory University School of Medicine, Atlanta, GA, USA.
J Nucl Cardiol. 2022 Apr;29(2):698-708. doi: 10.1007/s12350-020-02335-6. Epub 2020 Sep 7.
Computerized methodologies standardize the myocardial perfusion imaging (MPI) interpretation process.
To develop an automated relative perfusion quantitation approach for F-flurpiridaz, PET MPI studies from all phase III trial participants of F-flurpiridaz were divided into 3 groups. Count distributions were obtained in N = 40 normal patients undergoing pharmacological or exercise stress. Then, N = 90 additional studies were selected in a derivation group. Following receiver operating characteristic curve analysis, various standard deviations below the mean normal were used as cutoffs for significant CAD, and interobserver variability determined. Finally, diagnostic performance was compared between blinded visual readers and blinded derivations of automated relative quantitation in the remaining N = 548 validation patients.
Both approaches yielded comparable accuracies for the detection of global CAD, reaching 71% and 72% by visual reads, and 72% and 68% by automated relative quantitation, when using CAD ≥ 70% or ≥ 50% stenosis for significance, respectively. Similar results were observed when analyzing individual coronary territories. In both pharmacological and exercise stress, automated relative quantitation demonstrated significantly more interobserver agreement than visual reads.
Our automated method of F-flurpiridaz relative perfusion analysis provides a quantitative, objective, and highly reproducible assessment of PET MPI in normal and CAD subjects undergoing either pharmacological or exercise stress.
计算机方法使心肌灌注成像（MPI）的解释过程标准化。
为了开发一种用于 F-氟比拉嗪的自动相对灌注定量方法，将所有 F-氟比拉嗪三期临床试验参与者的 F-氟比拉嗪 PET MPI 研究分为 3 组。在 40 名接受药物或运动应激的正常患者中获得计数分布。然后，在推导组中选择了另外 90 项研究。在接受者操作特性曲线分析后，使用均值以下的各种标准偏差作为有意义的 CAD 的截止值，并确定了观察者间的变异性。最后，在 548 名验证患者中，将盲法视觉读数与自动相对定量的盲法推导进行比较，比较两种方法在检测整体 CAD 时的诊断性能。
两种方法在检测全球 CAD 方面的准确性相当，视觉阅读分别达到 71%和 72%，自动相对定量分别达到 72%和 68%，当分别使用 CAD≥70%或≥50%狭窄作为显著标准时。当分析各个冠状动脉区域时，也观察到了类似的结果。在药物和运动应激中，自动相对定量的观察者间一致性明显高于视觉阅读。
我们的 F-氟比拉嗪相对灌注分析自动化方法为接受药物或运动应激的正常和 CAD 患者的 PET MPI 提供了一种定量、客观和高度可重复的评估。
