Boomsma M M, Niemeyer M G, van der Wall E E, van Eck-Smit B L, Zwinderman A H, Boomsma J H, Pauwels E K
Department of Cardiology, Martini Hospital, Groningen, The Netherlands.
Int J Card Imaging. 1998 Apr;14(2):105-11. doi: 10.1023/a:1005930200119.
The purpose of this study was to evaluate the diagnostic value of Tc-99m tetrofosmin SPECT myocardial perfusion scintigraphy rest/stress and stress/rest protocols for the assessment of coronary artery disease (CAD).
65 patients underwent both rest and stress SPECT imaging in a one-day protocol and coronary angiography within 2 months before or after scintigraphy. Scintigraphic data was obtained according to two different protocols; 1) rest-stress (n = 18) and 2) stress-rest (n = 47).
Scintigraphic evidence for myocardial ischaemia was found in 36 patients (55%). The overall sensitivity to detect CAD (> 50% luminal stenosis) was 94% (34/36), specificity 66% (19/24), positive predictive value 77%, negative predictive value 90%. The sensitivity to detect CAD for protocols 1 and 2 were 100% and 93%, specificity 56% and 70%, positive predictive value 69% and 81% and negative predictive value 100% and 88%, respectively. The left anterior descending coronary artery showed a sensitivity (overall, protocol 1 & 2) of 78%, 75% (3/4) and 79% (15/19) and a specificity of 71%, 64% (9/14) and 75% (21/28). The right coronary artery showed a sensitivity (overall, protocol 1 & 2) of 91%, 100% (6/6) and 88% (14/16) and a specificity of 70%, 92% (11/12) and 61% (19/31). The left circumflex coronary artery showed a sensitivity (overall, protocol 1 & 2) of 50%, 67% (2/3) and 46% (6/13) and a specificity of 94%, 100% (15/15) and 91% (31/34).
Tc-99m tetrofosmin appears to be a valuable tool in predicting significant CAD. The sensitivity and the positive predictive value are high, making this test highly appropriate for the diagnosis of CAD. The diagnostic value of the individual coronary arteries is high to moderate. No significant differences were found between both protocols.
本研究旨在评估锝-99m替曲膦单光子发射计算机断层扫描（SPECT）心肌灌注显像静息/负荷及负荷/静息方案对冠状动脉疾病（CAD）评估的诊断价值。
65例患者在一日方案中接受了静息和负荷SPECT显像，并在显像前后2个月内进行了冠状动脉造影。根据两种不同方案获取显像数据；1）静息-负荷（n = 18）和2）负荷-静息（n = 47）。
36例患者（55%）发现心肌缺血的显像证据。检测CAD（管腔狭窄> 50%）的总体敏感性为94%（34/36），特异性为66%（19/24），阳性预测值为77%，阴性预测值为90%。方案1和方案2检测CAD的敏感性分别为100%和93%，特异性分别为56%和70%，阳性预测值分别为69%和81%，阴性预测值分别为100%和88%。左前降支冠状动脉的敏感性（总体、方案1和方案2）分别为78%、75%（3/4）和79%（15/19），特异性分别为71%、64%（9/14）和75%（21/28）。右冠状动脉的敏感性（总体、方案1和方案2）分别为91%、100%（6/6）和88%（14/16），特异性分别为70%、92%（11/12）和61%（19/31）。左旋支冠状动脉的敏感性（总体、方案1和方案2）分别为50%、67%（2/3）和46%（6/13），特异性分别为94%、100%（15/15）和91%（31/34）。
锝-99m替曲膦似乎是预测显著CAD的一种有价值的工具。敏感性和阳性预测值较高，使该检查非常适合CAD的诊断。各冠状动脉的诊断价值为高到中度。两种方案之间未发现显著差异。
