Segall G M, Atwood J E, Botvinick E H, Dae M W, Lucas J R
Nuclear Medicine Service, Department of Veterans Affairs Medical Center, Palo Alto, CA 94304, USA.
J Nucl Med. 1995 Jun;36(6):944-51.
Standard criteria for assigning perfusion defects to a specific vascular territory often result in mistaken identification of the affected coronary artery due to the normal variability of coronary anatomy. A retrospective study was performed to determine the frequency of this type of error and to identify the most common perfusion patterns associated with specific coronary lesions.
Records were reviewed of all patients with single-vessel coronary artery disease (CAD) who had exercise or dipyridamole thallium SPECT myocardial perfusion studies since 1987. Patients with coronary artery bypass grafts and an interval between the two studies greater than 6 wk or interval change in medical status were excluded. Ninety-three studies were available for review. The size, severity and location of all perfusion defects were noted by three observers who had no knowledge of the angiographic data. Significant CAD was defined as luminal diameter stenosis greater than 50%.
The diseased vessel was correctly identified in 85% of positive studies. Thallium SPECT, however, mistakenly predicted additional vessel involvement in 29% of those studies. Another 15% correctly predicted single-vessel disease but identified the wrong artery. Using standard criteria, thallium SPECT correctly predicted the arteriogram findings in only 56% of studies. Most of these findings could be correlated with variations in individual coronary anatomy.
The accurate localization of coronary stenoses by thallium SPECT imaging requires close correlation with arteriography owing to the significant variability in normal coronary anatomy.
由于冠状动脉解剖结构的正常变异性，将灌注缺损分配到特定血管区域的标准标准常常导致对受影响冠状动脉的错误识别。进行了一项回顾性研究，以确定这类错误的发生率，并识别与特定冠状动脉病变相关的最常见灌注模式。
回顾了自1987年以来所有患有单支冠状动脉疾病（CAD）且进行了运动或双嘧达莫铊心肌灌注显像的患者的记录。排除了接受冠状动脉搭桥手术以及两次研究间隔大于6周或病情发生变化的患者。共有93项研究可供审查。三位不了解血管造影数据的观察者记录了所有灌注缺损的大小、严重程度和位置。显著CAD定义为管腔直径狭窄大于50%。
在85%的阳性研究中正确识别了病变血管。然而，铊心肌灌注显像在29%的此类研究中错误地预测了其他血管受累情况。另有15%正确预测了单支血管病变，但识别错了动脉。使用标准标准，铊心肌灌注显像仅在56%的研究中正确预测了血管造影结果。这些发现大多与个体冠状动脉解剖结构的变异有关。
由于正常冠状动脉解剖结构存在显著变异性，铊心肌灌注显像对冠状动脉狭窄的准确定位需要与血管造影密切相关。
