Schroeder-Tanka J M, Tiel-van Buul M M, van der Wall E E, Roolker W, Lie K I, van Royen E A
Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands.
Int J Card Imaging. 1997 Aug;13(4):323-9. doi: 10.1023/a:1005767823114.
We addressed the question whether in patients with cardiac chest pain referred for stress myocardial perfusion scintigraphy, Tc-99m MIBI SPECT stress imaging should always be followed by a rest imaging procedure.
Using Tc-99m MIBI imaging a stress rest sequence is usually performed implying that the resting study always follows the stress study irrespective of the results of the stress study. As a normal stress study would eliminate a subsequent resting study, it appears desirable to potentially define certain subsets of patients in whom a normal stress study can be expected in order to determine a more selective referral approach to the nuclear medicine department. The consequences of such a more streamlined approach would less impose on the logistics of the department of nuclear medicine, with decrease of investigation time, radiation dose, and costs in a time of retrenchment in the medical sector.
A consecutive series of 460 patients (mean age 58.2 years) was studied who were stratified to 269 patients without prior myocardial infarction, and to 191 patients with documented evidence of a previously sustained myocardial infarction. All patients underwent Tc-99m MIBI SPECT imaging according to a two-day stress-rest protocol.
Patients with and without a previous myocardial infarction showed suboptimal overall predictive accuracies for the exercise electrocardiograms (58% and 60%, respectively). In the total group of 460 patients, 94 (20%) patients showed a normal stress-rest Tc-99m MIBI SPECT; this occurred in 86/269 (32%) patients without a previous myocardial infarction and in only 8/191 (4%) patients with a previous myocardial infarction.
Patients with a stress defect at Tc-99m MIBI SPECT imaging should always undergo a resting SPECT study irrespective of the clinical and stress electrocardiographic findings. As patients without a previous myocardial infarction had a normal stress SPECT study in almost one-third (32%) of patients compared to only 4% in patients with a previously myocardial infarction, it may be useful to employ different referral and imaging strategies i.e., a stress-only versus a stress-rest procedure. To schedule referring patients differently according to the presence or absence of a previously sustained myocardial infarction may be cost-saving, less demanding for the nuclear medicine personnel, and patient-convenient. In addition, a stress-only imaging procedure reduces radiation exposure to the individual patient.
我们探讨了对于因心脏胸痛而接受负荷心肌灌注闪烁扫描的患者，锝-99m甲氧基异丁基异腈单光子发射计算机断层扫描（Tc-99m MIBI SPECT）负荷成像后是否总是需要进行静息成像检查。
使用Tc-99m MIBI成像时，通常会进行负荷-静息序列检查，这意味着无论负荷检查结果如何，静息检查总是在负荷检查之后进行。由于正常的负荷检查可以排除后续的静息检查，因此似乎有必要确定某些有望获得正常负荷检查结果的患者亚组，以便确定一种更具选择性的转诊至核医学科的方法。这种更简化方法的后果将减少对核医学科后勤工作的影响，在医疗行业紧缩时期减少检查时间、辐射剂量和成本。
对连续的460例患者（平均年龄58.2岁）进行研究，这些患者被分为269例无既往心肌梗死的患者和191例有既往持续性心肌梗死记录证据的患者。所有患者均按照为期两天的负荷-静息方案接受Tc-99m MIBI SPECT成像检查。
有和无既往心肌梗死的患者运动心电图的总体预测准确性均欠佳（分别为58%和60%）。在460例患者的总体组中，94例（20%）患者的负荷-静息Tc-99m MIBI SPECT显示正常；这在86/269例（32%）无既往心肌梗死的患者中出现，而在仅8/191例（4%）有既往心肌梗死的患者中出现。
无论临床和负荷心电图结果如何，Tc-99m MIBI SPECT成像显示有负荷缺损的患者都应始终接受静息SPECT检查。由于无既往心肌梗死的患者中近三分之一（32%）负荷SPECT检查正常，而有既往心肌梗死的患者中这一比例仅为4%，因此采用不同的转诊和成像策略，即仅负荷检查与负荷-静息检查程序，可能是有用的。根据是否有既往持续性心肌梗死对转诊患者进行不同的安排可能节省成本、对核医学人员要求较低且方便患者。此外，仅负荷成像程序可减少个体患者所接受的辐射暴露。
