Arrighi J A, Ng C K, Dey H M, Wackers F J, Soufer R
Yale University-Veterans Affairs Positron Imaging Laboratory, Yale University School of Medicine, New Haven, Connecticut 06516, USA.
Am J Cardiol. 1997 Oct 15;80(8):1007-13. doi: 10.1016/s0002-9149(97)00594-8.
The accuracy of technetium-99m (Tc-99m) sestamibi single-photon emission computed tomography (SPECT) for the assessment of myocardial viability in patients with coronary artery disease and left ventricular (LV) dysfunction is not defined completely. This study determines whether the performance of Tc-99m sestamibi SPECT for viability detection differs between patients with mild-to-moderate coronary artery disease. Patients with regional and/or global LV dysfunction were separated into 2 groups on the basis of LV ejection fraction (EF) at rest: group 1 (LVEF > 25%, mean 36 +/- 6%, n = 9), and group 2 (LVEF < or = 25%, mean 17 +/- 5%, n = 11). All patients underwent semiquantitative Tc-99m sestamibi SPECT and positron emission tomography (PET) at rest with N-13 ammonia and F-18 fluorodeoxyglucose. The overall regional concordance of SPECT and PET for viability detection was 89% in group 1 and 78% in group 2 (p = 0.002). Discordance in group 2 was almost exclusively due to PET viable and/or SPECT nonviable regions. In regions with hypoperfusion at rest by PET, concordance was 78% in group 1 and only 64% in group 2 (p = 0.0015). In regions with reduced perfusion and relatively increased metabolic activity ("flow: metabolism mismatch"), Tc-99m sestamibi SPECT identified 88% of regions in group 1 as viable, but only 42% of regions in group 2 (p = 0.002). Thus, while Tc-99m sestamibi semiquantitative SPECT at rest shows a good concordance with PET for the detection of myocardial viability in patients with coronary artery disease with mild-to-moderate LV dysfunction, it may underestimate myocardial viability in patients with severe LV dysfunction, particularly in those patients with hypoperfusion at rest as assessed by PET.
锝-99m（Tc-99m）甲氧基异丁基异腈单光子发射计算机断层扫描（SPECT）用于评估冠状动脉疾病和左心室（LV）功能不全患者心肌存活性的准确性尚未完全明确。本研究确定了轻度至中度冠状动脉疾病患者中，Tc-99m甲氧基异丁基异腈SPECT检测心肌存活性的表现是否存在差异。根据静息时左心室射血分数（EF），将有局部和/或整体LV功能不全的患者分为2组：第1组（左心室射血分数>25%，平均36±6%，n = 9）和第2组（左心室射血分数≤25%，平均17±5%，n = 11）。所有患者均接受静息状态下的半定量Tc-99m甲氧基异丁基异腈SPECT检查以及用N-13氨和F-18氟脱氧葡萄糖进行的正电子发射断层扫描（PET）检查。第1组中SPECT和PET检测心肌存活性的总体局部一致性为89%，第2组为78%（p = 0.002）。第2组中的不一致几乎完全是由于PET显示存活而SPECT显示无活性的区域。在PET显示静息时灌注减低的区域，第1组的一致性为78%，第2组仅为64%（p = 0.0015）。在灌注减低且代谢活性相对增加（“血流：代谢不匹配”）的区域，Tc-99m甲氧基异丁基异腈SPECT将第1组中88%的区域识别为存活，但第2组中仅42%的区域（p = 0.002）。因此，虽然静息状态下的Tc-99m甲氧基异丁基异腈半定量SPECT在检测轻度至中度LV功能不全的冠状动脉疾病患者心肌存活性方面与PET显示出良好的一致性，但它可能会低估严重LV功能不全患者的心肌存活性，尤其是那些经PET评估静息时存在灌注减低的患者。
