心肌灌注单光子发射计算机断层显像与有创冠状动脉造影的三维融合指导冠状动脉血运重建。
Three-dimensional Fusion of Myocardial Perfusion SPECT and Invasive Coronary Angiography Guides Coronary Revascularization.
作者信息
Xu Zhihui, Tang Haipeng, Malhotra Saurabh, Dong Minghao, Zhao Chen, Ye Zekang, Zhou Ying, Xu Shun, Li Dianfu, Wang Cheng, Zhou Weihua
机构信息
Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Gulou, Nanjing, 210000, China.
School of Computing Sciences and Computer Engineering, University of Southern Mississippi, Hattiesburg, MS, 39406, USA.
出版信息
J Nucl Cardiol. 2022 Dec;29(6):3267-3277. doi: 10.1007/s12350-022-02907-8. Epub 2022 Feb 22.
BACKGROUND
SPECT myocardial perfusion imaging (SPECT MPI) and invasive coronary angiography (ICA) provide complementary clinical information in the diagnosis of coronary artery disease (CAD). We have developed an approach for 3D fusion of perfusion data from SPECT MPI and coronary anatomy from ICA. In this study, we aimed to evaluate its clinical value when compared to the traditional side-by-side readings.
METHODS
Thirty-six CAD patients who had at least one stenosis ≥ 50% were retrospectively enrolled. Based on the presence of a perfusion defect in a territory subtended by a coronary vessel, all vessels were classified as matched, unmatched, or normal groups via both the fusion and side-by-side analysis. The treatments recommended by the fusion and side-by-side analysis were compared with those that the patients received. Major adverse cardiac events (MACE), defined as all-cause death, myocardial infarction, unstable angina requiring hospitalization, and unplanned revascularization, were assessed.
RESULTS
The overall vessel-based concordance was 78.7% between the fusion and side-by-side analysis. Compared with the side-by-side analysis, 23 coronary arteries (29 equivocal segments) of 19 patients were reclassified via fusion of data. In the matched, unmatched, and normal groups, the numbers of vessels with hemodynamically significant stenosis which caused reversible defect were 37 vs 53, 28 vs 14, and 43 vs 41 (P < .01) when comparing the side-by-side analysis with the fusion, and the revascularization ratios per vessel were 69% vs 88%, 29% vs 10%, and 2% vs 2% between them. During the five-year follow-up, 8 patients (22.2%) experienced MACE. Patients who received the same treatment as the guidance of 3D fusion results (n = 22) had superior outcomes when compared with those who did not (n = 14) (P < .01).
CONCLUSIONS
Compared with the side-by-side analysis, the 3D fusion of SPECT MPI and ICA provided incremental diagnostic and prognostic value.
背景
单光子发射计算机断层扫描心肌灌注成像（SPECT MPI）和有创冠状动脉造影（ICA）在冠状动脉疾病（CAD）诊断中提供互补的临床信息。我们开发了一种将SPECT MPI的灌注数据与ICA的冠状动脉解剖结构进行三维融合的方法。在本研究中，我们旨在评估与传统的并排阅读相比其临床价值。
方法
回顾性纳入36例至少有一处狭窄≥50%的CAD患者。根据冠状动脉所供血区域存在灌注缺损情况，通过融合分析和并排分析将所有血管分为匹配组、不匹配组或正常组。将融合分析和并排分析推荐的治疗方案与患者实际接受的治疗方案进行比较。评估主要不良心脏事件（MACE），定义为全因死亡、心肌梗死、需住院治疗的不稳定型心绞痛和计划外血运重建。
结果
融合分析和并排分析之间基于血管的总体一致性为78.7%。与并排分析相比，19例患者的23条冠状动脉（29个可疑节段）通过数据融合重新分类。在匹配组、不匹配组和正常组中，比较并排分析与融合分析时，导致可逆性缺损的具有血流动力学显著狭窄的血管数量分别为37条对53条、28条对14条、43条对41条（P<0.01），且每组血管的血运重建率分别为69%对88%、29%对10%、2%对2%。在五年随访期间，8例患者（22.2%）发生MACE。接受与三维融合结果指导相同治疗的患者（n = 22）与未接受该指导的患者（n = 14）相比，结局更好（P<0.01）。
结论
与并排分析相比，SPECT MPI和ICA的三维融合提供了额外的诊断和预后价值。
Zotero 插件