Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, 167 Beilishi Road, Beijing, 100037, China.
Department of Nuclear Medicine, China-Japan Friendship Hospital, National Center for Respiratory Diseases, Beijing, China.
J Nucl Cardiol. 2023 Apr;30(2):769-780. doi: 10.1007/s12350-022-03085-3. Epub 2022 Aug 15.
The aim of this prospective multi-center study was to investigate the diagnostic value of myocardial blood flow (MBF) quantification using NaI(Tl)-based single-photon emission computed tomography (SPECT) for determining coronary artery disease (CAD) defined by quantitative coronary angiography (QCA).
Absolute quantitation of MBF and myocardial flow reserve (MFR) using SPECT is clinically feasible; however, whether flow quantification using NaI(Tl) SPECT is superior to commonly performed SPECT myocardial perfusion imaging (MPI) in determining CAD has not been evaluated.
Patients with suspected or known CAD underwent pharmacological stress/rest dynamic SPECT imaging and routine SPECT MPI followed by QCA. Obstructive disease was defined as ≥ 50% reduction in luminal diameter on QCA.
One hundred fifty-four patients (462 vessels) were included in the analysis. Obstructive CAD was detected in 76/154 patients (49.4%) and 112/462 vessels (24.2%). Optimal cut-off values were 1.86 mL/min/g for stress MBF and 1.95 for MFR, respectively. Stress MBF and MFR were more sensitive than MPI in both individual patients (stress MBF vs MPI: 81.6% vs 51.3%; MFR vs MPI: 72.4% vs 51.3%) and in coronary vascular regions (stress MBF vs MPI: 78.6% vs 31.3%; MFR vs MPI: 75.9% vs 31.3%; all P < .01). In receiver operating characteristic curve analysis, quantification revealed a significantly greater area under the curve than MPI at the patient (stress MBF vs MPI: 0.761 vs 0.641; MFR vs MPI: 0.770 vs 0.641) and the vessel (stress MBF vs MPI: 0.745 vs 0.613; MFR vs MPI: 0.756 vs 0.613; all P < .05) levels. Integrating quantitative SPECT measures with MPI significantly increased the area under the curve and improved the discriminatory and reclassification capacity.
Flow quantification using NaI(Tl) SPECT provides superior sensitivity and discriminatory capacity to MPI in detecting significant stenosis. Clinical trial registration NCT03637725.
本前瞻性多中心研究旨在探讨使用基于 NaI(Tl) 的单光子发射计算机断层扫描 (SPECT) 定量心肌血流 (MBF) 诊断冠状动脉疾病 (CAD) 的价值，CAD 由定量冠状动脉造影 (QCA) 定义。
使用 SPECT 进行 MBF 和心肌血流储备 (MFR) 的绝对定量在临床上是可行的；然而，使用 NaI(Tl) SPECT 进行血流定量是否优于常规进行的 SPECT 心肌灌注成像 (MPI) 来确定 CAD 尚未得到评估。
疑似或已知 CAD 的患者接受药物负荷/静息动态 SPECT 成像和常规 SPECT MPI 检查，然后进行 QCA。管腔狭窄定义为 QCA 上的管腔直径减少≥50%。
共纳入 154 例患者（462 支血管）进行分析。154 例患者中有 76 例（49.4%）和 462 支血管中有 112 支（24.2%）存在阻塞性 CAD。最佳截断值分别为应激 MBF 1.86 mL/min/g 和 MFR 1.95。与 MPI 相比，应激 MBF 和 MFR 在个体患者（应激 MBF 与 MPI：81.6%与 51.3%；MFR 与 MPI：72.4%与 51.3%）和冠状动脉血管区域（应激 MBF 与 MPI：78.6%与 31.3%；MFR 与 MPI：75.9%与 31.3%；均 P<.01）中均更敏感。在受试者工作特征曲线分析中，定量分析在患者（应激 MBF 与 MPI：0.761 与 0.641；MFR 与 MPI：0.770 与 0.641）和血管（应激 MBF 与 MPI：0.745 与 0.613；MFR 与 MPI：0.756 与 0.613；均 P<.05）水平上的曲线下面积均显著大于 MPI。将定量 SPECT 测量值与 MPI 相结合可显著提高曲线下面积，并提高区分能力和重新分类能力。
使用 NaI(Tl) SPECT 进行血流定量在检测显著狭窄方面提供了比 MPI 更高的敏感性和区分能力。临床试验注册号 NCT03637725。
