[静息及最大运动后用铊-201进行定量心肌闪烁扫描的结果——对预测价值及临床应用的批判性分析（作者译）]

[Results of quantitative myocardial scintigraphy with thallium-201 at rest and after maximum exercise--critical analysis of predictive value and clinical application (author's transl)].

作者信息

Schicha H, Rentrop P, Facorro L, Karsch K R, Blanke H, Kreuzer H, Emrich D

出版信息

Z Kardiol. 1980 Jan;69(1):31-42.

Abstract

In 20 normal individuals and 60 patients with CAD, myocardial scintigraphy with thallium-201 was performed after maximum exercise and two hours later at rest. The evaluation of digitized scintigrams was performed quantitatively by means of a 14-halfsegment model. Using ROC analysis, sensitivity and specificity were estimated. Furthermore the predictive value of a thallium scintigram was evaluated by means of the bayesian theorem, comparing the data with coronary angiography and partly also with exercise ventriculography. At a specificity of 90%, sensitivity of scintigraphy for CAD was 97% in 34 patients with previous myocardial infarction and 85% in 26 patients without infarction. Sensitivity for the extent of CAD was 93% for 44 vessels, perfusing infarcted myocardium and 67% for 96 vessels, perfusing non-infarcted myocardium. Sensitivity decreased with increasing extent of CAD and was higher for Cx than for LAD. The predictive value of a positive or negative scintigram was analyzed for different prevalences of CAD. At a low prevalence, e.g. 5%, the predictive value of a pathological scintigram is only 32%, consequently thallium scintigraphy is not applicable as a general screening procedure. At a high prevalence, e.g. 90%, the predictive value of a normal scintigram is only 40%. Therefore thallium scintigraphy seems not to be able to differentiate whether a coronary artery stenosis is hemodynamically significant or not. This was in agreement with the data from exercise cineventriculography. A high predictive value of thallium scintigraphy of about 85% is obtained only in the case of a medium prevalence of CAD, e.g. in asymptomatic patients with pathological Ecg or in patients with atypical angina pectoris. An improvement of the predictive value of myocardial scintigraphy would require other radionuclides than thallium-201, to use higher activities and to allow Ecg-gated myocardial scintigraphy.

摘要

对20名正常人和60名冠心病患者在最大运动量后进行铊-201心肌闪烁扫描，并于两小时后静息状态下再次扫描。通过一个14半段模型对数字化闪烁扫描图进行定量评估。采用ROC分析来估计敏感性和特异性。此外，通过贝叶斯定理评估铊闪烁扫描图的预测价值，并将数据与冠状动脉造影结果进行比较，部分还与运动心室造影结果进行比较。在特异性为90%时，对于34例既往有心肌梗死的患者，闪烁扫描对冠心病的敏感性为97%；对于26例无梗死的患者，敏感性为85%。对于灌注梗死心肌的44支血管，闪烁扫描对冠心病范围的敏感性为93%；对于灌注非梗死心肌的96支血管，敏感性为67%。敏感性随冠心病范围的增加而降低，且回旋支（Cx）的敏感性高于左前降支（LAD）。针对不同冠心病患病率分析了闪烁扫描图阳性或阴性的预测价值。在低患病率（如5%）时，异常闪烁扫描图的预测价值仅为32%，因此铊闪烁扫描不适用于一般筛查程序。在高患病率（如90%）时，正常闪烁扫描图的预测价值仅为40%。因此，铊闪烁扫描似乎无法区分冠状动脉狭窄在血流动力学上是否具有显著性。这与运动电影心室造影的数据一致。只有在冠心病患病率中等的情况下（如无症状但心电图异常的患者或非典型心绞痛患者），铊闪烁扫描的预测价值才约为85%。若要提高心肌闪烁扫描的预测价值，需要使用除铊-201之外的其他放射性核素，采用更高的活度，并进行心电图门控心肌闪烁扫描。