Taillefer R, DePuey E G, Udelson J E, Beller G A, Latour Y, Reeves F
Department of Nuclear Medicine, Hotel-Dieu De Montreal, Quebec, Canada.
J Am Coll Cardiol. 1997 Jan;29(1):69-77. doi: 10.1016/s0735-1097(96)00435-4.
This prospective study was conducted in 115 women to directly compare the sensitivity and specificity of thallium-201 (Tl-201), technetium-99m (Tc-99m) sestamibi perfusion and Tc-99m sestamibi electrocardiographic (ECG)-gated single-photon emission computed tomographic (SPECT) studies for detection of coronary artery disease (CAD).
Data on the comparative diagnostic accuracy of Tl-201 and Tc-99m sestamibi perfusion imaging for the detection of CAD, specifically in women, are very limited.
Eighty-five patients with suspected CAD, scheduled for coronary angiography, and 30 volunteers with a pretest likelihood of < or = 5% for CAD were evaluated. Within 1 week, each patient underwent Tl-201 and Tc-99m sestamibi SPECT imaging procedures (both perfusion and gated SPECT imaging). Treadmill stress testing was used in 78 patients and dipyridamole in the remaining 37 patients. All images were interpreted by three observers in a blinded manner (consensus reading). Technetium-99m sestamibi SPECT studies were read without and then with ECG gating. Technetium-99m sestamibi gated SPECT studies were used to differentiate scar tissue from soft tissue attenuation artifact.
The overall sensitivities for detecting > or = 50% and > or = 70% stenoses were 75.0% and 84.3%, respectively, for Tl-201, and 71.9% and 80.4%, respectively, for Tc-99m sestamibi perfusion studies (p = 0.48). The specificity for lesions > or = 50% was 61.9% for Tl-201 and 85.7% for Tc-99m sestamibi perfusion (p = 0.07), whereas for lesions > or = 70% it was 58.8% for Tl-201 and 82.4% for Tc-99m sestamibi perfusion (p = 0.01). When the 34 patients with a normal coronary angiogram were added to the group of 30 normal volunteers, the "specificity" for lesions > or = 70% was 67.2% for Tl-201, 84.4% for Tc-99m sestamibi SPECT perfusion (p = 0.02) and 92.2% for Tc-99m sestamibi gated SPECT (p = 0.0004).
Both Tl-201 SPECT and Tc-99m sestamibi SPECT perfusion studies had a similar sensitivity for the detection of CAD in women. However, Tc-99m sestamibi SPECT perfusion imaging shows a significantly better specificity, which is further enhanced by the use of ECG gating.
本前瞻性研究纳入了115名女性，旨在直接比较铊-201（Tl-201）、锝-99m（Tc-99m）甲氧基异丁基异腈灌注显像以及Tc-99m甲氧基异丁基异腈心电图（ECG）门控单光子发射计算机断层扫描（SPECT）检查对冠心病（CAD）的诊断敏感性和特异性。
关于Tl-201和Tc-99m甲氧基异丁基异腈灌注显像对CAD诊断准确性的比较数据，尤其是在女性中的数据非常有限。
对85例疑似CAD且计划进行冠状动脉造影的患者以及30例CAD预测试验可能性≤5%的志愿者进行评估。在1周内，每位患者均接受了Tl-201和Tc-99m甲氧基异丁基异腈SPECT显像检查（包括灌注显像和门控SPECT显像）。78例患者采用平板运动试验，其余37例患者采用双嘧达莫试验。所有图像均由3名观察者采用盲法解读（达成共识）。Tc-99m甲氧基异丁基异腈SPECT检查先在未进行ECG门控的情况下解读，然后再进行ECG门控解读。Tc-99m甲氧基异丁基异腈门控SPECT检查用于区分瘢痕组织和软组织衰减伪影。
对于检测≥50%和≥70%狭窄，Tl-201的总体敏感性分别为75.0%和84.3%，Tc-99m甲氧基异丁基异腈灌注显像的总体敏感性分别为71.9%和80.4%（p = 0.48）。对于≥50%的病变，Tl-201的特异性为61.9%，Tc-99m甲氧基异丁基异腈灌注显像的特异性为85.7%（p = 0.07）；而对于≥70%的病变，Tl-201的特异性为58.8%，Tc-99m甲氧基异丁基异腈灌注显像的特异性为82.4%（p = 0.01）。当将34例冠状动脉造影正常的患者加入30例正常志愿者组时，对于≥70%的病变，Tl-201的“特异性”为67.2%，Tc-99m甲氧基异丁基异腈SPECT灌注显像的“特异性”为84.4%（p = 0.02），Tc-99m甲氧基异丁基异腈门控SPECT的“特异性”为92.2%（p = 0.0004）。
Tl-20(SPECT)和Tc-99m甲氧基异丁基异腈SPECT灌注显像对女性CAD的检测敏感性相似。然而，Tc-99m甲氧基异丁基异腈SPECT灌注显像的特异性显著更高，且通过使用ECG门控可进一步提高特异性。
