Department of Radiology, University of British Columbia, .
BC Cancer, Vancouver, British Columbia, Canada, .
Nucl Med Commun. 2023 Dec 1;44(12):1087-1093. doi: 10.1097/MNM.0000000000001768. Epub 2023 Sep 14.
Stress-only single photon emission computed tomography myocardial perfusion imaging (MPI) offers numerous advantages in terms of improved workflow, cost and radiation reduction but is currently not widely utilized due to challenges in selecting appropriate patients for this technique.
Data from 5959 individuals were used to derive (N = 4018) and validate (N = 1941) a binomial logistic regression model to predict normal stress MPI studies (stress total perfusion deficit < 4%, ejection fraction ≥ 50%). Model performance was analyzed using receiver operator characteristic curves. A simplified point-scoring system was developed and its impact on imaging workflow was assessed.
Significant predictors of abnormal vs. normal stress MPI included male sex, age > 65 years, cardiomyopathy, congestive heart failure, myocardial infarction, angina, and pharmacological stress. The final model and simplified scoring system were associated with areas under the curve of 0.81 (95% CI 0.79-0.83) and 0.80 (95% CI 0.79-0.82) in the validation group, respectively. Use of the scoring system was estimated to result in a decrease of 56.5% in the number of non-contributory imaging studies acquired with minimal patient rescheduling.
A prediction tool derived from simple clinical information can identify candidates for stress-only MPI studies with a beneficial impact on departmental workflow.
仅应激单光子发射计算机断层心肌灌注成像（MPI）在改善工作流程、降低成本和减少辐射方面具有诸多优势，但由于在选择适合该技术的患者方面存在挑战，目前尚未得到广泛应用。
利用 5959 名个体的数据，建立（N=4018）并验证（N=1941）了二项逻辑回归模型，以预测正常应激 MPI 研究（应激总灌注缺损<4%，射血分数≥50%）。使用受试者工作特征曲线分析模型性能。开发了一种简化的评分系统，并评估了其对成像工作流程的影响。
异常与正常应激 MPI 相比的显著预测因子包括男性、年龄>65 岁、心肌病、充血性心力衰竭、心肌梗死、心绞痛和药物应激。最终模型和简化评分系统在验证组中的曲线下面积分别为 0.81（95%CI 0.79-0.83）和 0.80（95%CI 0.79-0.82）。使用评分系统估计可减少 56.5%的无贡献成像研究数量，同时最小化患者重新安排。
从简单的临床信息中得出的预测工具可以识别适合仅应激 MPI 研究的候选者，对部门工作流程产生有益影响。
