Department of Nuclear Medicine, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City, 220, Taiwan.
Department of Nuclear Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi County, Taiwan.
J Nucl Cardiol. 2022 Oct;29(5):2311-2321. doi: 10.1007/s12350-021-02713-8. Epub 2021 Jul 8.
Balanced ischemia with multi-vessel coronary artery disease (CAD) is difficult to diagnose with semiquantitative single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). Dynamic cardiac SPECT provides quantitative estimations of stenosis severity and ischemic burden by assessing myocardial flow reserve (MFR) and myocardial blood flow (MBF). The aim of this study was to evaluate the incremental value of dynamic SPECT in multi-vessel coronary artery disease (CAD).
Patients with suspected CAD who underwent dynamic ECG-gated dipyridamole MPI and coronary angiography within 6 months were retrospectively reviewed. The performance of summed stress, rest and difference scores (SSS, SRS, SDS), post-stress and resting MBF (MBF, MBF) and MFR were compared at both patient level and vessel level.
In 32 patients with 39 stenotic vessels, 12 had three-vessel disease (38%). Globally increased SSS and impaired MBF values were significantly associated with significant CAD at the patient level, but SDS and MFR were not. Regional increases in SSS and reductions in both MBF and MBF were significantly associated with stenotic vessels. The best cutoff value of global MBF to predict CAD was 3.5 ml·g·min (area under the curve, AUC = .84, P = .002). The best cutoff value of regional MBF to detect significant stenosis was 3.6 ml·g·min (AUC = .74, P < .001). However, the best possible cut-off values of MFR were not found. Sex-difference in both global and regional MBF but MBF was found, which might result in the non-significance in MFR.
This study validated a clinically available method to quantify MFR using dynamic CZT-SPECT. This method improved the detectability of multi-vessel CAD, and absolute MBF was superior to MFR and other semiquantitative MPI parameters.
多支冠状动脉疾病（CAD）的平衡缺血难以通过半定量单光子发射计算机断层扫描（SPECT）心肌灌注成像（MPI）进行诊断。动态心脏 SPECT 通过评估心肌血流储备（MFR）和心肌血流（MBF），提供狭窄严重程度和缺血负担的定量估计。本研究旨在评估动态 SPECT 在多支 CAD 中的附加价值。
回顾性分析了在 6 个月内接受动态心电图门控双嘧达莫 MPI 和冠状动脉造影的疑似 CAD 患者。比较了患者水平和血管水平的总和应激、休息和差值评分（SSS、SRS、DSS）、应激后和休息时的 MBF（MBF、MBF）和 MFR 的表现。
在 32 名患有 39 个狭窄血管的患者中，12 名患者患有三支血管疾病（38%）。全局 SSS 增加和 MBF 值受损与患者水平上的显著 CAD 显著相关，但 DSS 和 MFR 则不然。SSS 局部增加以及 MBF 和 MBF 均降低与狭窄血管显著相关。预测 CAD 的全局 MBF 的最佳截断值为 3.5ml·g·min（曲线下面积，AUC=0.84，P=0.002）。检测显著狭窄的局部 MBF 的最佳截断值为 3.6ml·g·min（AUC=0.74，P<0.001）。然而，没有找到 MFR 的最佳可能截断值。发现了全局和局部 MBF 以及 MBF 的性别差异，这可能导致 MFR 不显著。
本研究验证了一种使用动态 CZT-SPECT 定量测量 MFR 的临床可用方法。该方法提高了多支 CAD 的检测能力，绝对 MBF 优于 MFR 和其他半定量 MPI 参数。
