Schwartz R S, Jackson W G, Celio P V, Richardson L A, Hickman J R
Clinical Sciences Division, United States Air Force School of Aerospace Medicine, Brooks AFB, Tex. 78235-5000.
Circulation. 1993 Jan;87(1):165-72. doi: 10.1161/01.cir.87.1.165.
Little is known about the diagnostic usefulness of 201Tl scintigraphy for detecting asymptomatic coronary artery disease in apparently healthy men. We thus evaluated planar 201Tl exercise myocardial scintigraphy in 845 asymptomatic male military aircrew undergoing coronary arteriography because of abnormal noninvasive tests suggesting possible myocardial ischemia.
Patients were stratified by prior disease risk into six subgroups using age (< 45 and > or = 45 years) and ratio of total to high density lipoprotein cholesterol (< 4.5, 4.5-6.0, and > 6.0). Significant coronary artery disease (> or = 50% diameter stenosis in any major coronary artery) was present in 143 (16.9% prevalence). Overall sensitivity and specificity of 201Tl scintigraphy adjusted for verification bias were estimated to be 45 +/- 4% and 78 +/- 1%, respectively. These values are lower than corresponding values accepted for clinical populations. Positive and negative predictive values varied across subgroups. A normal thallium scan indicated low risk of disease, but an abnormal test was likely to be a false-positive result. A logistic equation was retrospectively fit to the data for estimating the probability of disease given age, cholesterol ratio, and thallium results. Within each quintile of estimated risk, the average risk did not differ significantly from the observed disease prevalence.
Exercise 201Tl scintigraphy is limited by the frequent occurrence of false-positive tests in detecting asymptomatic, anatomic coronary artery disease in young men in accordance with Bayesian probability theory.
对于201铊闪烁扫描术在检测表面健康男性无症状冠状动脉疾病方面的诊断效用知之甚少。因此，我们对845名无症状男性军事飞行人员进行了平面201铊运动心肌闪烁扫描术检查，这些人员因非侵入性检查异常提示可能存在心肌缺血而接受冠状动脉造影。
根据年龄（<45岁和≥45岁）以及总胆固醇与高密度脂蛋白胆固醇之比（<4.5、4.5 - 6.0和>6.0）将患者按既往疾病风险分为六个亚组。143例（患病率16.9%）存在显著冠状动脉疾病（任何主要冠状动脉直径狭窄≥50%）。经验证偏倚调整后的201铊闪烁扫描术总体敏感性和特异性估计分别为45±4%和78±1%。这些值低于临床人群公认的相应值。阳性和阴性预测值在各亚组中有所不同。铊扫描正常表明疾病风险较低，但检查异常很可能是假阳性结果。对数据进行回顾性拟合得到一个逻辑方程，用于根据年龄、胆固醇比值和铊扫描结果估计疾病概率。在每个估计风险五分位数内，平均风险与观察到的疾病患病率无显著差异。
根据贝叶斯概率理论，运动201铊闪烁扫描术在检测年轻男性无症状解剖学冠状动脉疾病时受假阳性检查频繁出现的限制。
