CZT动态SPECT成像定量评估心肌血流和冠状动脉血流储备对疑似冠心病患者的诊断效能：与传统半定量评估的比较研究
Diagnostic efficiency of quantification of myocardial blood flow and coronary flow reserve with CZT dynamic SPECT imaging for patients with suspected coronary artery disease: a comparative study with traditional semi-quantitative evaluation.
作者信息
Wang Jiao, Li Shuai, Chen Weiqiang, Chen Yue, Pang Zekun, Li Jianming
机构信息
Department of Nuclear Medicine, TEDA International Cardiovascular Hospital, Tianjin Medical University Clinical Cardiovascular Institute, Tianjin, China.
Department of Cardiology, TEDA International Cardiovascular Hospital, Tianjin Medical University Clinical Cardiovascular Institute, Tianjin, China.
出版信息
Cardiovasc Diagn Ther. 2021 Feb;11(1):56-67. doi: 10.21037/cdt-20-728.
BACKGROUND
Myocardial blood flow (MBF) quantitation with cadmium-zinc-telluride (CZT) dynamic single-photon emission computed tomography (SPECT) is being increasingly investigated toward clinical utilization.
METHODS
In this prospective study, forty-nine patients with suspected or known coronary artery disease (CAD) underwent a rest/adenosine triphosphate (ATP) stress dynamic and routine gated myocardial perfusion imaging (MPI) by CZT SPECT and then received coronary angiography (CAG). Quantitative diagnosis from the dynamic SPECT and a flow diagram was automatically obtained by the dedicated software and compared with the result of semi-quantitative analysis with gated MPI using the angiographic stenosis as the reference standard.
RESULTS
When stenosis ≥50% was considered at the participant level, the sensitivity (SN), specificity (SP), positive predictive value (PPV), negative predictive value (NPV) and accuracy (AC) of the quantitative diagnosis were higher than semi-quantitative method as (84.4% 65.6%, 88.2% 70.6%, 93.1% 80.8%, 75.0% 52.2%, 85.7% 67.3%) (all P<0.05). The receiver operating characteristic (ROC) curve analysis generated the optimal critical value as 1.86 and 1.61 mL/min/g for stress MBF (sMBF) and MFR, respectively. The diagnosis performance of the quantitative diagnosis was higher than semi-quantitative method as (78.9% 68.4%, 63.3% 60.0%, 57.7% 52.0%, 82.6% 75.0%, 69.4% 63.3%) for the criteria of ≥75% stenosis on CAG (all P<0.05) with optimal critical values as 1.71 and 1.15 mL/min/g. There was no significant difference between sMBF and MFR.
CONCLUSIONS
The diagnostic efficiency by using the quantitative method of CZT dynamic SPECT imaging is superior to traditional semi-quantitative gated MPI for the diagnosis of CAD, which improved the diagnostic specificity and accuracy when the critical was stenosis ≥50%.
背景
利用碲锌镉（CZT）动态单光子发射计算机断层扫描（SPECT）定量心肌血流量（MBF）正越来越多地被研究用于临床。
方法
在这项前瞻性研究中，49例疑似或已知冠状动脉疾病（CAD）的患者接受了静息/三磷酸腺苷（ATP）负荷动态及常规门控心肌灌注成像（MPI）检查，采用CZT SPECT，随后接受冠状动脉造影（CAG）。通过专用软件自动获得动态SPECT的定量诊断结果和流程图，并以血管造影狭窄为参考标准，与门控MPI的半定量分析结果进行比较。
结果
当以参与者水平考虑狭窄≥50%时，定量诊断的敏感性（SN）、特异性（SP）、阳性预测值（PPV）、阴性预测值（NPV）和准确性（AC）均高于半定量方法，分别为（84.4%对65.6%，88.2%对70.6%，93.1%对80.8%，75.0%对52.2%，85.7%对67.3%）（所有P<0.05）。受试者工作特征（ROC）曲线分析得出，负荷心肌血流量（sMBF）和心肌血流储备（MFR）的最佳临界值分别为1.86和1.61 mL/min/g。对于CAG上≥75%狭窄标准，定量诊断的诊断性能高于半定量方法，分别为（78.9%对68.4%，63.3%对60.0%，57.7%对52.0%，82.6%对75.0%，69.4%对63.3%）（所有P<0.05），最佳临界值为1.71和1.15 mL/min/g。sMBF和MFR之间无显著差异。
结论
使用CZT动态SPECT成像定量方法的诊断效率优于传统的半半定量门控MPI用于CAD的诊断，当临界狭窄≥50%时提高了诊断特异性和准确性。
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