Zhang F F, Yang X Y, Shao X L, Wang J F, Chen Y J, Liu B, Shi Y M, Yu W J, Wang Y T
Department of Nuclear Medicine, the Third Affiliated Hospital of Soochow University, the First People's Hospital of Changzhou, Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, Changzhou 213003, China.
Department of Cardiology, the Third Affiliated Hospital of Soochow University, the First People's Hospital of Changzhou, Changzhou 213003, China.
Zhonghua Yi Xue Za Zhi. 2025 May 13;105(18):1392-1399. doi: 10.3760/cma.j.cn112137-20250304-00508.
To compare the diagnostic value of rest F-fluorodeoxyglucose (F-FDG) positron emission tomography (PET) myocardial ischemic memory imaging and rest Tc-methoxyisobutylisonitrile (MIBI) single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) for obstructive coronary artery disease (CAD) in patients with suspected unstable angina (UA). This prospective study included low-and medium-risk patients who presented with chest pain or discomfort at the Chest Pain Center or Cardiovascular Department of the Third Affiliated Hospital of Soochow University from September 2020 to June 2024. These patients, whose initial clinical assessments were negative but still suspected of UA, all underwent rest Tc-MIBI SPECT MPI, rest F-FDG PET myocardial ischemic memory imaging, and invasive coronary angiography (ICA). Using ICA as the diagnostic gold standard, the diagnostic value of rest Tc-MIBI SPECT MPI and rest F-FDG PET myocardial ischemic memory imaging were compared for obstructive CAD in suspected UA patients. The diagnostic performance was assessed using receiver operating characteristic curves. A total of 274 patients with suspected UA were included, of whom 158 (57.7%) had ICA confirmed obstructive CAD [112 males(70.9%), aged (64.3±10.3) years], and 116 (42.3%) had no obstructive CAD [61 males(52.6%), aged (65.4±8.4) years].Rest F-FDG PET myocardial ischemic memory imaging demonstrated significantly higher sensitivity (67.7% vs 52.5%), specificity (90.5% vs 78.4%), positive predictive value (90.7% vs 76.9%), negative predictive value (67.3% vs 54.8%), accuracy (77.4% vs 63.5%), and the area under the curve [0.79 (95% 0.74-0.84) vs 0.66 (95% 0.60-0.71)] compared to rest Tc-MIBI SPECT MPI (all <0.05). The net reclassification improvement (NRI) index for the diagnosis of obstructive CAD using rest F-FDG PET myocardial ischemic memory imaging over Tc-MIBI SPECT MPI was 0.27 (95%: 0.14-0.41), and the difference was statistically significant (<0.05). Rest F-FDG PET myocardial ischemic memory imaging demonstrates superior diagnostic performance compared to Tc-MIBI SPECT MPI for obstructive CAD in patients with suspected UA.
比较静息氟脱氧葡萄糖（F-FDG）正电子发射断层扫描（PET）心肌缺血记忆成像与静息锝-甲氧基异丁基异腈（MIBI）单光子发射计算机断层扫描（SPECT）心肌灌注成像（MPI）对疑似不稳定型心绞痛（UA）患者阻塞性冠状动脉疾病（CAD）的诊断价值。这项前瞻性研究纳入了2020年9月至2024年6月期间在苏州大学附属第三医院胸痛中心或心血管内科因胸痛或不适就诊的低、中风险患者。这些患者初始临床评估为阴性但仍疑似UA，均接受了静息Tc-MIBI SPECT MPI、静息F-FDG PET心肌缺血记忆成像及有创冠状动脉造影（ICA）检查。以ICA作为诊断金标准，比较静息Tc-MIBI SPECT MPI和静息F-FDG PET心肌缺血记忆成像对疑似UA患者阻塞性CAD的诊断价值。采用受试者操作特征曲线评估诊断性能。共纳入274例疑似UA患者，其中158例（57.7%）经ICA证实有阻塞性CAD[112例男性（70.9%），年龄（64.3±10.3）岁]，116例（42.3%）无阻塞性CAD[61例男性（52.6%），年龄（65.4±8.4）岁]。与静息Tc-MIBI SPECT MPI相比，静息F-FDG PET心肌缺血记忆成像的敏感性（67.7%对52.5%）、特异性（90.5%对78.4%）、阳性预测值（90.7%对76.9%）、阴性预测值（67.3%对54.8%）、准确性（77.4%对63.5%）及曲线下面积[0.79（95% 0.74-0.84）对0.66（95% 0.60-0.71）]均显著更高（均P<0.05）。静息F-FDG PET心肌缺血记忆成像相对于Tc-MIBI SPECT MPI诊断阻塞性CAD的净重新分类改善（NRI）指数为0.27（95%：0.14-0.41），差异有统计学意义（P<0.05）。对于疑似UA患者的阻塞性CAD，静息F-FDG PET心肌缺血记忆成像的诊断性能优于Tc-MIBI SPECT MPI。
