静息门控单光子发射计算机断层心肌灌注显像仅心电图判断时，局部室壁运动异常对疑诊冠心病患者检测阻塞性冠状动脉疾病的附加价值。

Incremental value of regional wall motion abnormalities for detecting obstructive coronary artery disease by rest-only electrocardiogram-gated single-photon emission computerized tomography myocardial perfusion imaging in suspected coronary artery disease patients.

机构信息

Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University.

Changzhou Key Laboratory of Molecular Imaging, Changzhou, Jiangsu Province.

出版信息

Nucl Med Commun. 2021 Mar 1;42(3):276-283. doi: 10.1097/MNM.0000000000001335.

DOI:10.1097/MNM.0000000000001335

PMID:33252509

Abstract

OBJECTIVE

The purpose of this study was to determine whether regional wall motion (WM) abnormalities by rest-only 99mtechnetium-sestamibi (99mTc-MIBI) electrocardiogram (ECG)-gated single-photon emission computerized tomography (SPECT) myocardial perfusion imaging (MPI) had incremental diagnostic value for detecting obstructive coronary artery disease (CAD) in suspected CAD patients.

METHODS

This study retrospectively studied 255 consecutive suspected CAD patients who underwent rest-only ECG-gated SPECT MPI and were performed coronary angiography within 3 months. Obstructive CAD was defined as ≥70% narrowing of the inner diameter of the left anterior descending coronary artery, left circumflex coronary artery and right coronary artery or their main branches and ≥50% narrowing of the left main coronary artery. QPS and QGS were used to assess rest perfusion and WM. Summed rest score ≥4 and summed motion score ≥2 exhibited in two consecutive segments in one territory was considered abnormal.

RESULTS

The sensitivity of the combination of perfusion and regional WM abnormalities was significantly higher than perfusion alone for detecting obstructive CAD (46.8% vs. 30.9%; P < 0.001), with similar specificity (91.9% vs. 95.0; P = 0.063). The global chi-square value of combination of perfusion and WM increased from 31.40 to 50.71 (P < 0.001) compared to perfusion. The sensitivity of combination of perfusion and WM for detecting obstructive CAD in patients with multivessel disease was higher than single-vessel disease (56.1% vs. 25.0%; P < 0.001), with similar specificity.

CONCLUSION

Regional WM abnormalities at rest, as shown by rest-only 99mTc-MIBI ECG-gated SPECT MPI, have additional diagnostic value over perfusion alone for detecting obstructive CAD in suspected CAD patients.

摘要

目的

本研究旨在确定静息状态下仅行 99m 锝-甲氧基异丁基异腈（99mTc-MIBI）心电图门控单光子发射计算机断层扫描（SPECT）心肌灌注显像（MPI）的局部室壁运动（WM）异常是否对疑似冠心病（CAD）患者中检测阻塞性 CAD 具有附加诊断价值。

方法

本研究回顾性分析了 255 例连续疑似 CAD 患者，这些患者在 3 个月内进行了静息状态下仅行 ECG 门控 SPECT MPI 检查和冠状动脉造影。阻塞性 CAD 定义为左前降支、左回旋支和右冠状动脉或其主要分支的内径狭窄≥70%和左主干狭窄≥50%。使用 QPS 和 QGS 评估静息期灌注和 WM。同一区域的两个连续节段出现总和静息评分≥4 和总和运动评分≥2 被认为异常。

结果

灌注和区域性 WM 异常联合的敏感性显著高于灌注单独检测阻塞性 CAD（46.8% vs. 30.9%；P < 0.001），特异性相似（91.9% vs. 95.0%；P = 0.063）。与灌注相比，灌注和 WM 联合的整体卡方值从 31.40 增加到 50.71（P < 0.001）。灌注和 WM 联合检测多支病变患者阻塞性 CAD 的敏感性高于单支病变（56.1% vs. 25.0%；P < 0.001），特异性相似。