Demangeat J L, Gries P, Bessekri A, Fellinger F
Department of Nuclear Medicine, General Hospital, Haguenau, France.
J Nucl Cardiol. 1997 Sep-Oct;4(5):349-57. doi: 10.1016/s1071-3581(97)90025-8.
A prospective study was conducted to evaluate the clinical usefulness of three-dimensional (3D) surface-shaded maps for routine practice of myocardial perfusion single-photon emission computed tomography (SPECT) by comparison with 2D slices and 2D bull's-eye qualitative analysis.
Angiograms were performed on 201 consecutive patients, 155 with coronary artery disease (CAD) and 46 with no significant CAD. One-day 201TI stress/rest-reinjection protocol was performed in 110 patients, and 1-day 99mTc-sestamibi or tetrofosmin stress/rest protocol was performed in 91. The stress protocol was either exercise or dipyridamole (0.56 mg/kg) infusion. Three-dimensional surface maps were obtained by using a threshold for the transaxial data at 50%, 55%, 60%, 65%, and 70% of the maximum pixel value in the first 60 patients. Interpretation of 3D maps was based on the presence of a complete (transmural-looking) perfusion hole within the myocardial wall; doubtful patterns were considered pathologic or normal. Good diagnostic values were found for the 50% to 60% thresholds, but the 60% setting showed the best concordance with multislice and bull's-eye analysis; higher values drastically degraded the specificity. Considering doubtful patterns as normal clarified interpretation and led to a small loss in sensitivity but high gain in specificity. Applied to the whole population, the 3D maps using a 60% threshold provided similar diagnostic value to detect CAD as did conventional and bull's-eye analysis. Moreover, the 3D maps showed a trend toward higher specificity and a proportionally smaller decrease in sensitivity (sensitivity: 92.9%, 90.3%, 89.7%; specificity: 45.6%, 50.0%, 58.7% for tomograms, bull's-eye analysis, and 3D maps, respectively), especially for the detection of left anterior descending and right CAD. Multivessel disease was detected in an identical manner. Three-dimensional maps might improve detection of perfusion defects in the basal regions. However, 3D maps were found to be less sensitive than slices and particularly bull's-eye analysis for the reversibility of stress defects.
Three-dimensional surface display of myocardial perfusion is a valuable independent tool for determining presence, extent, and location of CAD. It can convey useful first-look information to the referring physician, especially through a cine-rotational motion (as done in our practice through use of a floppy disk.
进行了一项前瞻性研究，通过与二维切片和二维靶心定性分析相比较，评估三维（3D）表面阴影图在心肌灌注单光子发射计算机断层扫描（SPECT）常规检查中的临床实用性。
对201例连续患者进行了血管造影，其中155例患有冠状动脉疾病（CAD），46例无明显CAD。110例患者采用一日201铊负荷/静息-再注射方案，91例采用一日99m锝- sestamibi或替曲膦负荷/静息方案。负荷方案为运动或双嘧达莫（0.56mg/kg）静脉输注。在前60例患者中，通过对横轴位数据使用最大像素值的50%、55%、60%、65%和70%的阈值来获得三维表面图。3D图的解读基于心肌壁内是否存在完整（透壁样）灌注缺损；可疑模式被视为病理性或正常。发现50%至60%的阈值具有良好的诊断价值，但60%的设置与多层和靶心分析显示出最佳一致性；更高的值会大幅降低特异性。将可疑模式视为正常可简化解读，并导致敏感性略有下降，但特异性显著提高。应用于整个研究人群时，使用60%阈值的3D图在检测CAD方面提供了与传统分析和靶心分析相似的诊断价值。此外，3D图显示出特异性更高的趋势，敏感性下降比例相对较小（敏感性：断层扫描、靶心分析和3D图分别为92.9%、90.3%、89.7%；特异性：分别为45.6%、50.0%、58.7%），尤其是在检测左前降支和右冠状动脉疾病时。多支血管病变的检测方式相同。3D图可能会改善对基底区域灌注缺损的检测。然而，发现3D图在检测负荷缺损的可逆性方面比切片尤其是靶心分析的敏感性更低。
心肌灌注的三维表面显示是确定CAD的存在、范围和位置的有价值的独立工具。它可以向转诊医生传达有用的初步观察信息，特别是通过电影旋转运动（如我们在实践中通过使用软盘所做的那样）。
