Division of Cardiology, Cook County Health, Chicago, USA.
Division of Cardiology, Rush Medical College, Chicago, USA.
J Nucl Cardiol. 2021 Feb;28(1):104-111. doi: 10.1007/s12350-020-02328-5. Epub 2020 Sep 8.
Tc-99m pyrophosphate (PYP) SPECT is recommended for indeterminate findings on planar imaging. We aimed to compare the findings on planar PYP scintigraphy alone to that of routinely performed PYP SPECT.
PYP scintigraphy data of 133 patients (53% men; mean age 76 years) were evaluated. SPECT was routinely performed following 1-hour planar imaging, in all cases. Semiquantitative visual score and heart-to-contralateral (H/CL) ratio were determined in all patients as recommended.
PYP images from 35 patients (26%) were considered to be positive based on SPECT myocardial uptake. Among them, 20 (57%) had a H/CL ratio ≥1.5 and 34 had a visual score ≥ 2. SPECT identified myocardial uptake in one patient with a visual score < 2 and refuted the presence of myocardial uptake in two patients with a visual score ≥ 2. Visual score correlated well with SPECT (r = 0.94; P < .0001) and had an accuracy of 98% for tomographic myocardial uptake. Addition of H/CL ratio reduced the diagnostic performance of visual score.
Planar-derived visual score has an excellent accuracy for tomographic myocardial uptake, though it misclassifies a small proportion of patients. H/CL ratio decreases the diagnostic certainty of planar imaging. Tomographic imaging prevents misdiagnoses and should always be performed.
Tc-99m 焦磷酸盐（PYP）SPECT 适用于平面成像上的不确定发现。我们旨在比较单独进行平面 PYP 闪烁显像与常规进行的 PYP SPECT 的结果。
对 133 例患者（53%为男性；平均年龄 76 岁）的 PYP 闪烁显像数据进行评估。所有患者均在 1 小时平面成像后常规进行 SPECT。按照推荐，对所有患者进行半定量视觉评分和心脏与对侧（H/CL）比值的测定。
根据 SPECT 心肌摄取情况，35 例患者（26%）的 PYP 图像被认为是阳性。其中，20 例（57%）的 H/CL 比值≥1.5，34 例的视觉评分≥2。SPECT 在一位视觉评分<2 的患者中识别出心肌摄取，在两位视觉评分≥2 的患者中反驳了心肌摄取的存在。视觉评分与 SPECT 相关性良好（r=0.94；P<0.0001），对断层心肌摄取的准确性为 98%。H/CL 比值的增加降低了视觉评分的诊断性能。
平面衍生的视觉评分对断层心肌摄取具有出色的准确性，尽管它错误分类了一小部分患者。H/CL 比值降低了平面成像的诊断确定性。断层成像可防止误诊，应始终进行。
