Benoit T, Vivegnis D, Lahiri A, Itti R, Braat S, Rigo P
University Hospital, Liège, Belgium.
Eur Heart J. 1996 Apr;17(4):635-42. doi: 10.1093/oxfordjournals.eurheartj.a014919.
Technetium-99m tetrofosmin is a new myocardial imaging agent with improved handling and kinetic characteristics. The purpose of this study was to compare the ability of planar and SPECT Tc-99m tetrofosmin imaging with Thallium-201 planar data to detect coronary artery disease and individual vessel lesions ( > 50% diameter stenosis). Seventy-two patients with definite or suspected coronary artery disease were included. Sixty-three had angiographic evidence of coronary artery disease, among whom 42 had had a previous myocardial infarction, while 21 had not. The total number of diseased arteries was 111. Patients underwent symptom-limited treadmill or bicycle exercise to similar endpoints. Thallium and tetrofosmin images were analysed separately by consensus reading. Interpretation was made for five standard anatomical regions (anterior, septal, inferior, lateral and apex), classified into four categories (normal, reversible, fixed and mixed defects). Sensitivity and specificity to detect coronary artery disease were 71% and 78% for Thallium-201 vs 68% and 78% for tetrofosmin by planar imaging, and 87% and 89% for tetrofosmin by SPECT. The improved sensitivity of SPECT was confirmed both in patients with and without previous myocardial infarction. The sensitivity to detect individual vessel lesions was improved by SPECT (59% tetrofosmin SPECT vs 50% thallium planar and 51% tetrofosmin planar). Individual vessel lesion detection by SPECT was 50% for the left anterior descending coronary artery, 42% for the left circumflex and 86% for the right coronary artery. This study confirms the value of technetium-99m tetrofosmin as a myocardial imaging agent. Improvements in diagnosis and in evaluating extent of disease can be expected from using SPECT.
锝-99m 替曲膦是一种新型心肌显像剂，其处置和动力学特性得到了改善。本研究的目的是比较平面及单光子发射计算机断层扫描（SPECT）锝-99m 替曲膦显像与铊-201 平面显像检测冠状动脉疾病及单个血管病变（直径狭窄>50%）的能力。纳入了 72 例确诊或疑似冠状动脉疾病的患者。其中 63 例有冠状动脉疾病的血管造影证据，其中 42 例曾有过心肌梗死，21 例未曾有过。病变血管总数为 111 条。患者进行症状限制性平板运动或自行车运动至相似终点。铊和替曲膦图像分别通过一致读片进行分析。对五个标准解剖区域（前壁、间隔、下壁、侧壁和心尖）进行解读，分为四类（正常、可逆、固定和混合性缺损）。平面显像时，铊-201 检测冠状动脉疾病的敏感性和特异性分别为 71%和 78%，替曲膦分别为 68%和 78%；SPECT 检测替曲膦的敏感性和特异性分别为 87%和 89%。在有或无既往心肌梗死的患者中，SPECT 提高的敏感性均得到了证实。SPECT 检测单个血管病变的敏感性有所提高（替曲膦 SPECT为 59%，而铊平面显像为 50%，替曲膦平面显像为 51%）。SPECT 检测单个血管病变时，左前降支冠状动脉为 50%，左旋支为 42%，右冠状动脉为 86%。本研究证实了锝-99m 替曲膦作为心肌显像剂的价值。使用 SPECT 有望改善疾病的诊断及评估疾病范围。
