Sciagrà R, Bisi G, Santoro G M, Briganti V, Leoncini M, Fazzini P
Department of Clinical Pathophysiology, University of Florence, Italy.
J Nucl Med. 1994 Aug;35(8):1254-64.
The aims of this study were: (1) to test whether first-pass radionuclide angiocardiography (FPRNA) adds useful information to perfusion scintigraphy; and (2) to assess the relative accuracy of perfusion and functional imaging in combination with dipyridamole for the evaluation of CAD.
Thirty patients with angiographically proven CAD (17 with prior infarction) were studied on separate days at rest and with dipyridamole infusion (0.7 mg/kg over 4 min). Tomographic images were evaluated using an uptake score. Dipyridamole FPRNA was considered positive in case of stress-induced wall motion abnormality or ejection fraction decrease.
The CAD detection rate of perfusion imaging was 100%, while that of FPRNA was 70% using wall motion criteria, 63% using ejection fraction response and 77% considering any abnormality. For CAD localization, perfusion imaging showed 76% sensitivity, 96% specificity and 82% accuracy. FPRNA results were 50%, 100% and 60%, respectively. Perfusion imaging was significantly superior to FPRNA also excluding from the analysis the infarct-related vessels. FPRNA did not identify multivessel CAD, which was correctly detected by perfusion imaging in most cases. Both techniques were more sensitive in case of > or = 90% stenosis, but the difference was more remarkable for FPRNA (sensitivity 65% versus 14%, p < 0.0005).
Dipyridamole FPRNA did not add noteworthy clinical information to perfusion imaging regarding CAD detection and evaluation of disease extent. The main contribution of a positive FPRNA was its relation with coronary obstruction severity. These results confirm the superiority of perfusion over functional imaging in combination with coronary vasodilators.
本研究的目的是：（1）测试首次通过放射性核素心血管造影（FPRNA）是否能为灌注闪烁显像增加有用信息；（2）评估灌注成像和功能成像联合双嘧达莫用于评估冠心病（CAD）的相对准确性。
30例经血管造影证实患有CAD的患者（17例有既往梗死史）在不同日期分别于静息状态及输注双嘧达莫（4分钟内输注0.7mg/kg）时接受研究。断层图像采用摄取评分进行评估。若出现应激诱导的室壁运动异常或射血分数降低，则双嘧达莫FPRNA被视为阳性。
使用室壁运动标准时，灌注成像对CAD的检出率为100%，而FPRNA为70%；使用射血分数反应时，FPRNA为63%；考虑任何异常情况时，FPRNA为77%。对于CAD定位，灌注成像显示敏感性为76%，特异性为96%，准确性为82%。FPRNA的结果分别为50%、100%和60%。在分析中排除梗死相关血管后，灌注成像也显著优于FPRNA。FPRNA未识别出多支血管CAD，而在大多数情况下灌注成像能正确检测出。两种技术在狭窄程度≥90%时都更敏感，但FPRNA的差异更显著（敏感性分别为65%和14%，p<0.0005）。
双嘧达莫FPRNA在CAD检测及疾病范围评估方面，并未为灌注成像增加值得注意的临床信息。FPRNA阳性的主要作用在于其与冠状动脉阻塞严重程度的关系。这些结果证实了在联合冠状动脉血管扩张剂时，灌注成像优于功能成像。
