Lavalaye J M, Schroeder-Tanka J M, Tiel-van Buul M M, van der Wall E E, Lie K I, van Royen E A
Department of Nuclear Medicine, Academic Medical Centre, Amsterdam, The Netherlands.
Int J Card Imaging. 1997 Aug;13(4):331-5. doi: 10.1023/a:1005767525788.
In a previous study in 460 patients, we found that in patients with suspected or known coronary artery disease undergoing stress-rest technetium-99m sestamibi (MIBI) SPECT myocardial perfusion imaging, rest SPECT imaging could be withhold in approximately 20% of patients because of a completely normal stress study. The present study was set up to evaluate the consequences of the implementation of this finding in a subsequent population of patients, and to set standards for the variety of protocols now used for MIBI SPECT imaging.
Within a period of 4 months, 235 consecutive patients referred for MIBI SPECT scintigraphy were studied. All patients had stable cardiac chest pain and underwent symptom-limited exercise MIBI SPECT perfusion imaging. The stress SPECT images were reconstructed and evaluated immediately after acquisition of the images. In case of a clearly normal stress SPECT study, rest imaging was cancelled.
Twenty-six of 235 patients (11%) had a completely normal stress MIBI SPECT study and the rest SPECT imaging procedure could be subsequently cancelled. In 20 patients (9%) the stress SPECT was inconclusive, and in 189 (80%) of patients stress imaging was clearly abnormal. In the first month of the study, the nuclear medicine physicians and cardiologists would interprete only 6% of the stress images as normal, while this number increased to 13% after 9 weeks, with a mean of 11% for the whole investigation period of 4 months.
In patients undergoing stress MIBI SPECT imaging, it was found justified to cancel rest MIBI SPECT imaging in at least 11% of patients because of a completely normal stress SPECT. As 9% of the images were inconclusive, the number of normal stress images could theoretically increase to 20% if reliable measures are taken to improve reading accuracy. This number is in close agreement with the number of normal stress studies previously reported by our institution and would lead to a considerable reduction of radiation dose, costs, and increased convenience for an important subset of patients.
在之前一项针对460例患者的研究中，我们发现，在接受静息-负荷锝-99m甲氧基异丁基异腈（MIBI）单光子发射计算机断层扫描（SPECT）心肌灌注成像的疑似或已知冠心病患者中，约20%的患者因负荷检查完全正常而可省略静息SPECT成像。本研究旨在评估在后续患者群体中应用这一发现的后果，并为目前用于MIBI SPECT成像的各种方案制定标准。
在4个月的时间内，对235例连续接受MIBI SPECT闪烁扫描的患者进行了研究。所有患者均有稳定的胸痛症状，并接受了症状限制运动MIBI SPECT灌注成像。负荷SPECT图像在采集后立即重建并评估。如果负荷SPECT研究明显正常，则取消静息成像。
235例患者中有26例（11%）负荷MIBI SPECT研究完全正常，随后可取消静息SPECT成像程序。20例患者（9%）的负荷SPECT结果不明确，189例患者（80%）的负荷成像明显异常。在研究的第一个月，核医学医生和心脏病专家仅将6%的负荷图像解读为正常，而9周后这一数字增加到13%，在4个月的整个研究期间平均为11%。
在接受负荷MIBI SPECT成像的患者中，发现至少11%的患者因负荷SPECT完全正常而取消静息MIBI SPECT成像是合理的。由于9%的图像结果不明确，如果采取可靠措施提高解读准确性，正常负荷图像的数量理论上可增加到20%。这一数字与我们机构之前报告的正常负荷研究数量密切一致，并将导致辐射剂量、成本大幅降低，同时为相当一部分患者带来更大便利。
