心肌灌注断层显像和电子束CT检查不同年龄冠心病的比较研究

目的 比较心肌灌注断层显像（ＭＰＩ）和电子束ＣＴ（ＥＢＣＴ）诊断〉４５岁与≤４５岁（ＣＡＤ）患者的价值。方法 将６４例临床拟诊为ＣＡＤ的患者按年龄分为Ａ组和Ｂ组。均进行ＥＢＣＴ探查冠状动脉钙化,＾９９Ｔｃ＾ｍ－甲氧基异丁基异腈（ＭＩＢＩ）ＭＰＩ和冠状动脉造影（ＣＡＧ）。     

^99mTc—MIBI心肌灌注显像与电子束CT诊断冠心病的比较

目的比较９９ｍＴｃ甲氧基异丁基异腈（ＭＩＢＩ）心肌ＳＰＥＣＴ显像与电子束ＣＴ（ＥＢＣＴ）冠状动脉钙化（ＣＡＣ）定量积分对冠心病诊断的价值。方法２１例经冠状动脉造影确诊的病人同时进行９９ｍＴｃＭＩＢＩ心肌ＳＰＥＣＴ显像（潘生丁介入试验）及ＥＢＣＴ检查，以冠状动脉造影为金标准，以决策矩阵法评价心肌ＳＰＥＣＴ及ＥＢＣＴ的临床应用价值。结果心肌ＳＰＥＣＴ显像灵敏度为９１％，特异性为８０％，准确性为８６％；ＥＢＣＴ以钙化积分≥１００为阳性标准，则其灵敏度、特异性和准确性分别为５５％、１００％及７６％。结论心肌ＳＰＥＣＴ显像和ＥＢＣＴ冠状动脉ＣＡＣ定量积分法均为非创伤性检查法，对冠心病的诊断各具优势及局限性，有互补作用     

99m Tc-MIBI心肌显像对冠状动脉病变的定位研究

目的：探讨９９ｍＴｃ－ＭＩＢＩ心肌显像在检出冠心病病变心肌节段和病变血管定位上的价值。方法：对照分析２０例冠心病和５例对照组冠状动脉造影与９９ｍＴｃ－ＭＩＢＩ单光子发射断层显像（ＳＰＥＣＴ）的结果。结果：潘生丁负荷ＳＰＥＣＴ检出冠心病、病变血管和病变心肌节段的敏感性分别为９５．００％、６３．６４％和４３．６８％明显高于静息相的６０．００％、４２．４２％和２７．５９％（Ｐ＜０．０１）。与静息相比较,潘生丁负荷ＳＰＥＣＴ多发现３３．３３％的病变血管和３６．８４％的病变心肌节段。对病变血管的敏感性,ＬＡＤ高于ＲＣＡ和ＬＣＸ;对于病变心肌节段检测敏感性ＲＣＡ支配节段高于ＬＡＤ和ＬＣＸ,特异性均较高。结论：潘生丁ＳＰＥＣＴ能显著提高冠心病的检出,有效估计病变心肌范围和病变冠状动脉     

^99mTc—MIBI心肌灌注断层显像潘生丁试验对冠心病诊断及疗效…

对７０例＾９９ｍＴｃ－ＭＩＢＩ心肌灌注断层显像潘生丁试验（ＣＴＤ）及ＥＣＧ结果与冠状动脉造影（ＣＡ）进行对照分析，结果表明：ＣＴＤ检测冠状动脉管腔狭窄≥５０％病变的灵敏度和特异性分别是８８％和９３％，明显高于ＥＣＧ（５２％和７７％），检出左前降支（ＬＡＤ）、左回旋支（ＬＣＸ）及右冠状动脉（ＲＣＡ）病变的灵敏度分别为８２％、８４％及８３％；检测冠状动脉单支病变的灵敏度为８２％，检出轻、中、重度狭窄的     

心肌灌注断层显像和冠状动脉造影结果不一致分析

回顾性分析了４０８例住院病人冠状动脉造影（ＣＡＧ）和心肌灌注显像（ＭＰＩ）的资料。所有ＭＰＩ检查用Ｔｏｓｈｉｂａ９０Ｂ型ＳＰＥＣＴ仪和Ｓｉｅｍｅｎｓ三探头ＳＰＥＣＴ仪完成。以ＣＡＧ示冠状动脉狭窄≥５０％为有临床意义的冠状动脉狭窄，４０８例中ＣＡＧ结果和ＭＰＩ结果不符合者２５例（６１％）。２５例病人平均年龄５１７±１０５岁，男２２例，女３例。ＭＰＩ显示心肌缺血和（或）心肌梗塞而ＣＡＧ正常者１５例，其中临床诊断为Ｘ综合征７例、陈旧性心肌梗塞３例、心绞痛（冠状动脉狭窄３０％～４０％）、高血压病、心肌肿瘤、扩张型心肌病和睡眠呼吸暂停综合征各１例；ＭＰＩ显示正常而ＣＡＧ有临床意义狭窄者共１０例（狭窄５０％～６０％者５例次，累及右冠状动脉者５例次，分支狭窄者５例次，运动量不足１例次，伴良好侧支循环２例次）。因此，心肌断层显像不正常而ＣＡＧ正常者，不能认为显像均为假阳性，其中有７３％的ＭＰＩ诊断与临床诊断符合；心肌显像阴性、ＣＡＧ证实狭窄≥５０％，大部分为冠状动脉远端分支狭窄和临界性冠状动脉狭窄及右冠状动脉狭窄或为运动量不足。     

核素心肌灌注显像与电子束CT诊断冠心病的对比研究

目的比较核素心肌ＳＰＥＣＴ显像与电子束ＣＴ（ＥＢＣＴ）扫描对冠心病（ＣＨＤ）的诊断价值。方法对６４例受检者（ＣＨＤ患者５０例，非ＣＨＤ患者１４例）进行了冠状动脉造影、ＳＰＥＣＴ及ＥＢＣＴ检查。结果以冠状动脉造影为金标准，ＳＰＥＣＴ与ＥＢＣＴ诊断ＣＨＤ的灵敏度相近，分别为９２０％和９４０％；ＳＰＥＣＴ的特异性（９２９％）优于ＥＢＣＴ（２８６％），Ｐ＜００５。在判断ＥＢＣＴ结果时，采用不同的钙化积分阈值，对诊断ＣＨＤ的灵敏度和特异性影响很大，故应采用接收器工作特性分析确定适当的钙化积分阈值。结论ＥＢＣＴ虽具有一定优越性，但目前尚不能取代心肌ＳＰＥＣＴ显像。     

~(99m）Tc－MIBI心肌灌注断层显像潘生丁试验对冠心病诊断及疗效观察的临床价值

对７０例９９ｍＴｃ－ＭＩＢＩ心肌灌注断层显像潘生丁试验（ＣＴＤ）及ＥＣＧ结果与冠状动脉造影（ＣＡ）进行对照分析，结果表明：ＣＴＤ检测冠状动脉管腔狭窄≥５０％病变的灵敏度和特异性分别是８８％和９３％，明显高于ＥＣＧ（５２％和７７％），检出左前降支（ＬＡＤ）、左回旋支（ＬＣＸ）及右冠状动脉（ＲＣＡ）病变的灵敏度分别为８２％、８４％及８３％；检测冠状动脉单支病变的灵敏度为８２％，检出轻、中、重度狭窄的灵敏度分别是４４％、８１％、１００％．对１７例经皮腔内冠状动脉成形术（ＰＴＣＡ）患者的术前术后ＣＴＤ结果进行了分析．结果表明ＣＴＤ对于诊断冠心病的灵敏度和特异性都很高，对筛选ＰＴＣＡ术前病人以及手术疗效评价和追踪观察有很重要的临床价值．     

99Tcm-MIBI运动-静息心肌显像在PTCA术后的临床价值

目的 评价＾９９Ｔｃ＾ｍ－甲氧基异丁基异腈（ＭＩＢＩ）运动－静息心肌（ＳＴ－ＲＥ）ＳＰＥＣＴ显像对经皮冠状动脉腔内成形（ＰＴＣＡ）术后判断疗效、预测再狭窄以及估测预后的临床价值。方法 １００例ＰＴＣＡ术后患者行ＳＴ－ＲＥ ＳＰＥＣＴ,３０例有术前对照,３０例复查冠状动脉造影（ＣＡＧ）,被扩冠状动脉所支配的心肌显像如为可逆性（ＲＤ）和（或）部分可逆性缺损（ＰＲＤ）,提示心肌缺血,冠状动脉再狭窄可能。     

门控~（99m）Tc－MIBI心肌断层显像诊断多支冠状动脉病变和心肌缺血

目的：评价门控心肌显像诊断冠心病（ＣＡＤ）的临床意义。方法：对３２例ＣＡＤ患者的９９ｍＴｃ—甲氧基异丁基异腈（ＭＩＢＩ）门控。非门控心肌断层显像和冠状动脉造影进行了比较，以及对４０例ＣＡＤ患者的门控与常规潘生丁─静息心肌断层显像也作了比较。结果：１．门控与非门控显像法诊断ＣＡＤ的灵敏度和特异性无差别，但前者对检测病变冠状动脉和诊断多支冠状动脉病变性ＣＡＤ的灵敏度高于后者，而特异性无差别。２．射血分数（ＥＦ）值显著影响非门控图像的病变显示。３．与非门控显像比较，门控显像能观察到更多的再分布节段和较少的无再分布节段。静息门控心肌显像除发现较多的灌注异常外，还观察到了许多单纯收缩功能受损节段。后者虽然可判断８４％的灌注再分布节段，但特异性不高。结论：门控心肌断层显像对诊断ＣＡＤ无优势，但对诊断ＥＦ值较高的或多支冠状动脉病变性ＣＡＤ、检测病变冠状动脉和心肌缺血有一定价值。     

扩张型心肌病和缺血性心肌病心肌灌注,代谢及功能的综合评价

目的 探讨核素显像在扩张性心肌病（ＤＣＭ）的缺血性心肌病（ＣＡＤ－ＤＭ）诊断及鉴别诊断中的作用。方法 对２８例ＤＣＭ和５５例ＣＡＤ－ＣＭ均行＾９９Ｔｃ＾ｍ－甲氧基异丁基异腈（ＭＩＢＩ）静息心肌灌注ＳＰＥＣＴ及＾１８Ｆ－脱氧葡萄糖（ＦＤＧ）心肌代谢ＰＥＴ显像，其中７３例行核素心室显像，６８例做冠状动脉造影。结果 心肌灌注显像２３例（８２％）ＤＣＭ为不呈节段分布的、散在的稀疏，４例（１４％）有灌注缺损     

Added value of coronary artery calcium score as an adjunct to gated SPECT for the evaluation of coronary artery disease in an intermediate-risk population.

The coronary artery calcium (CAC) score is a readily and widely available tool for the noninvasive diagnosis of atherosclerotic coronary artery disease (CAD). The aim of this study was to investigate the added value of the CAC score as an adjunct to gated SPECT for the assessment of CAD in an intermediate-risk population. METHODS: Seventy-seven prospectively recruited patients with intermediate risk (as determined by the Framingham Heart Study 10-y CAD risk score) and referred for coronary angiography because of suspected CAD underwent stress (99m)Tc-tetrofosmin SPECT myocardial perfusion imaging (MPI) and CT CAC scoring within 2 wk before coronary angiography. The sensitivity and specificity of SPECT alone and of the combination of the 2 methods (SPECT plus CAC score) in demonstrating significant CAD (>/=50% stenosis on coronary angiography) were compared. RESULTS: Forty-two (55%) of the 77 patients had CAD on coronary angiography, and 35 (45%) had abnormal SPECT results. The CAC score was significantly higher in subjects with perfusion abnormalities than in those who had normal SPECT results (889 +/- 836 [mean +/- SD] vs. 286 +/- 335; P < 0.0001). Similarly, with rising CAC scores, a larger percentage of patients had CAD. Receiver-operating-characteristic analysis showed that a CAC score of greater than or equal to 709 was the optimal cutoff for detecting CAD missed by SPECT. SPECT alone had a sensitivity and a specificity for the detection of significant CAD of 76% and 91%, respectively. Combining SPECT with the CAC score (at a cutoff of 709) improved the sensitivity of SPECT (from 76% to 86%) for the detection of CAD, in association with a nonsignificant decrease in specificity (from 91% to 86%). CONCLUSION: The CAC score may offer incremental diagnostic information over SPECT data for identifying patients with significant CAD and negative MPI results.     

Diagnostic pathway of integrated SPECT/CT for coronary artery disease

Treatment strategy in patients with suspected coronary artery disease (CAD) is driven by symptomatology in combination with diagnostic evaluation of the extent and/or severity of atherosclerosis in the coronary arteries and ischemia in the myocardium, i.e., the anatomic and functional correlates of CAD. Whereas multislice row computed tomography (MSCT) has the advantage of detecting coronary atherosclerosis at its earliest stages, thereby allowing initiation of appropriate therapeutic measures well before development of obstructive CAD, myocardial perfusion imaging (MPI) SPECT can clarify the hemodynamic consequences of the anatomic findings on MSCT based on a functional assessment of myocardial blood flow. There is a lack of correlation between coronary artery calcium (CAC), coronary artery stenosis, and MPI SPECT. Therefore CAC scoring and stress MPI should be thus considered complementary approaches rather than exclusionary in the evaluation of the patient at risk for CAD. The integration of anatomic and functional information may provide additional information for the clinician by the improved risk stratification and diagnostic accuracy of integrated techniques. The majority of previous studies are based on a sequential flowchart, starting with either SPECT or CAC scoring that finally directs the therapeutic strategy. Patients at low risk for CAD can be selected for primary prevention, and patients at high risk for CAD can be directly selected for coronary angiography (CAG). The remaining group of patients at intermediate risk for CAD can be substratified into lower- and higher-risk categories based on the presence or absence of stress-induced ischemia on MPI SPECT and CAC scoring. An integration of SPECT and CAC as a starting point for CAD detection in symptomatic patients at intermediate risk for CAD may facilitate a tailored diagnostic as well as therapeutic approach. Finally, using SPECT/CT, MPI SPECT, and CAC findings may be completed with CT angiography. The development of SPECT/CT hybrid systems is therefore of important value for the nuclear cardiology armamentarium. This editorial commentary outlines a diagnostic pathway of integrated SPECT/CT for CAD assessment in symptomatic patients at intermediate risk for CAD.     

Sensitivity,specificity and accuracy of stress SPECT myocardial perfusion imaging for detection of coronary artery disease in the distribution of first-order branch vessels,using an anatomical matching of angiographic and perfusion data

We sought to investigate the utility of stress single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) for the identification of coronary artery disease (CAD) in the distribution of first-order branch vessels. We evaluated 135 consecutive patients with coronary angiography and stress SPECT MPI. We anatomically matched angiography and SPECT to assess the sensitivity, specificity and accuracy of SPECT MPI for the detection of CAD in the distribution of first-order branches. Subgroup analysis for stress test performance and previous coronary artery bypass grafting (CABG) was also performed. The sensitivity, specificity and accuracy of stress SPECT MPI for the detection of CAD in the distribution of first-order branch vessels were all 67%. For isolated branch vessel CAD, stress SPECT MPI had a sensitivity of 44%. In patients without CABG, the sensitivity, specificity and accuracy for the detection of CAD in the distribution of first-order branch vessels were 71%, 67% and 68%, compared with 60%, 67% and 64% for patients with CABG. The sensitivity for isolated branch vessel CAD was 50% for patients without CABG, but only 29% for patients with CABG. The sensitivity and specificity for CAD in the distribution of branch vessels were similar for all patients for all stress test modalities and heart rate response (sensitivity, 64-69%; specificity, 61-69%). Stress SPECT MPI offers intermediate sensitivity, specificity and accuracy for the detection of CAD in the distribution of first-order coronary artery branch vessels. However, for isolated branch vessel CAD, stress SPECT has a lower sensitivity, particularly in patients with previous CABG.     

Cardiac CT angiography (CTA) and nuclear myocardial perfusion imaging (MPI)-a comparison in detecting significant coronary artery disease

RATIONALE AND OBJECTIVES: Endowed with sufficient diagnostic accuracy, electron beam computed tomography angiography (CTA) is being increasingly used to evaluate coronary arteries. However, data on direct comparisons with nuclear myocardial perfusion studies are limited. In this study, we sought to compare the accuracies of CTA and myocardial perfusion imaging (MPI) for identifying symptomatic patients with hemodynamically significant obstructive coronary artery disease (CAD). MATERIALS AND METHODS: In a single-center study, symptomatic outpatients who were scheduled for cardiac catheterization were prospectively enrolled. Only patients with exertional angina or dyspnea were included. After fulfilling the inclusion criteria, 30 patients were enrolled in the study (mean age 54 +/- 9 years and 70% males). Patients underwent MPI, CTA including coronary artery calcification (CAC) measure, and invasive coronary angiography for evaluation of obstructive coronary artery disease. Significant CAD was defined as >50% left main artery stenosis or >70% stenosis of any other epicardial vessel by invasive angiography. The sensitivities, specificities and predictive values of MPI, CAC, and CTA were analyzed per patient RESULTS: CTA demonstrated significant higher sensitivity than MPI (95% vs. 81%, P < .05). CTA demonstrated significantly higher specificity than both MPI (89% versus 78%, P = .04) and CAC (56%, P = .002). CTA also performed better in a per-vessel analysis (sensitivity 94%, specificity 96%) than both nuclear and CAC. There were no significant differences between the sensitivities and specificities of MPI and CAC. CONCLUSION: CTA accurately detects obstructive CAD in symptomatic patients and may be more accurate than MPI or CAC assessment. Larger studies in a more diverse population are needed.     

SPECT／CT显像评价“功能相关冠状动脉病变”的价值

目的探讨SPECT／CT显像评价“功能相关冠状动脉（简称冠脉）病变”的可行性及临床价值。方法40例可疑或确诊冠心病患者同机完成^99Tcm-甲氧基异丁基异腈（MIBI）负荷／静息心肌灌注断层显像和冠脉CT造影（CTCA）。负荷／静息心肌灌注显像采用标准二日法,首日行腺苷负荷心肌灌注显像,次日行静息心肌灌注显像及CTCA。腺苷按患者体质量以0．84mg·kg^-1·min^-1经静脉泵匀速给药,CTCA使用标准自动对比剂跟踪扫描程序完成。通过专用融合软件将心肌血流灌注与冠脉三维成像图融合,评价心肌缺血与冠脉病变的相关关系,确定“功能相关冠脉病变”。结果40例患者,CTCA正常20例,异常20例;120支冠脉中共检出33支病变血管,累及左前降支15支,左回旋支9支,右冠脉9支。心肌灌注显像正常22例,心肌缺血和（或）心肌梗死18例。SPECT心肌灌注和CTCA融合图像显示供血区心肌血流灌注正常且无狭窄冠脉占总的无狭窄冠脉的92．47％（86／93）,狭窄〈75％的冠脉中,其供血区心肌缺血或梗死的阳性率占42．86％（6／14,例）,狭窄〉75％或闭塞冠脉中,其供血区心肌缺血的阳性率占92．31％（12／13,例）。120支冠状动脉中20．83％（25／120,支）的病变冠脉为“功能相关冠脉病变”,检测出27例患者中25．93％（7／27,例）有无狭窄病变的冠脉导致心肌缺血;使15．38％（2／13,例）冠脉病变患者免除有创性诊断检查;指导对42．86％（6／14,例）的狭窄〈75％冠脉行药物治疗或冠脉血管重建术治疗;为1支狭窄〉75％的冠脉无需行血管重建术提供依据。结论SPECT／CT心肌灌注和CTCA融合显像可确定“功能相关冠脉病变”,可提供综合信息诊断冠心病和指导治疗。     

The relationship between stress-induced myocardial ischemia and coronary artery atherosclerosis measured by hybrid SPECT/CT camera

Objective  

The coronary artery calcium (CAC) score and myocardial perfusion imaging can now be detected simultaneously using a hybrid SPECT/CT camera. However, there has been little evaluation on the relationship between stress-induced ischemia and coronary artery calcification in a Japanese population. The aim of this study was to investigate the relationship between these parameters and to elucidate the diagnostic value of the CAC score as an adjunct to myocardial perfusion imaging (MPI) for the assessment of coronary artery disease (CAD) in an intermediate-risk population.     

Different manifestations of coronary artery disease by stress SPECT myocardial perfusion imaging,coronary calcium scoring,and multislice CT coronary angiography in asymptomatic patients with type 2 diabetes mellitus

Background. We sought to assess prospectively the evidence for silent coronary artery disease (CAD) in asymptomatic patients with type 2 diabetes mellitus by stress single-photon emission computed tomography (SPECT) myocardial perfusion imaging, coronary artery calcium (CAC) scoring, and multislice computed tomographic (MSCT) coronary angiography. Methods. One hundred asymptomatic patients (aged 30 to 72 years) with type 2 diabetes mellitus and one or more risk factors for CAD were prospectively recruited from an outpatient diabetes clinic. All patients underwent adenosine technetium-99m sestamibi SPECT imaging, CAC scoring, and 64-slice MSCT coronary angiography. Results. Twenty-three patients (23%) had abnormal stress SPECT imaging, consistent with inducible myocardial ischemia, whereas 60 patients (60%) had positive CAC scoring (18 patients [18%] with significant CAC >401), and 70 patients (70%) had abnormal MSCT coronary angiography (24 patients [24%] with significant, ≥50% stenosis). Of 77 patients with normal SPECT, 44 had a positive CAC score (10 patients [13%] >401), and 54 showed CAD on MSCT angiography (16 patients [21%] with ≥50% stenosis). Of 23 patients with an abnormal SPECT, 16 patients had a positive CAC score (8 patients [35%] >401), and 16 patients had CAD on MSCT angiography (8 patients [35%] with ≥50% stenosis). Overall, 17 patients (17%) had more than 2 significantly abnormal diagnostic test results, and 5 patients had three tests with significantly abnormal results. Conclusions. In this cohort of asymptomatic patients with type 2 diabetes mellitus, different modalities visualized different aspects of silent coronary atherosclerosis. Anatomic evidence of coronary atherosclerosis (CAC and MSCT) occurred more frequently than functional evidence (stress SPECT). However, clinically significant manifestations of CAD were observed in about one-quarter to one-fifth of patients by each modality, either separately or combined. The relative prognostic value of each modality needs to be determined by a follow-up of this cohort. This work was supported by an unrestricted grant from BMS Medical Imaging. In addition, J.J.B. has received research grants from GE Healthcare.     

Stress single photon emission computed tomography for detection of coronary artery disease and risk stratification of asymptomatic patients at moderate risk

Background  The American College of Cardiology Foundation/American Society of Nuclear Cardiology appropriateness criteria document assigns single photon emission computed tomography myocardial perfusion imaging (SPECT MPI) a rating of uncertain for detection and risk assessment of coronary artery disease (CAD) in asymptomatic patients at moderate risk. Methods and Results  The nuclear cardiology database was used to identify 260 asymptomatic patients (67 ± 8 years, 72% men) without known CAD who were at moderate CAD risk according to the Framingham risk score. SPECT MPI images were categorized using the summed stress score (SSS). Mean follow-up 9.9 ± 3.0 years. Abnormal SPECT MPI scans were present in 142 patients (55%). By SSS categories, SPECT scans were low-risk in 67%, intermediate-risk in 20%, and high-risk in 13% of patients. Overall survival at 10 years was 79%, significantly better than the age- and gender-matched Minnesota general population (P < 0.001). Survival was 60% for patients with high-risk scans (95% CI 45-80%), 79% with intermediate-risk scans (95% CI 69-91%), and 83% with low-risk scans (95% CI 77-88%) (P = 0.03), including 84% (95% CI 77-91%) with normal scans. Conclusions  In this retrospectively identified group of asymptomatic patients at moderate CAD risk, stress SPECT MPI was effective for the detection and risk stratification of CAD. Average annual mortality was 4.0% in patients with high-risk scans vs 1.6% in patients with normal scans.     

A comparison of 99Tcm-MIBI myocardial SPET and electron beam computed tomography in the assessment of coronary artery disease in two different age groups

The aim of this study was to compare the clinical value of 99Tcm-MIBI single photon emission tomography (SPET) and electron beam computed tomography (EBCT) in the assessment of coronary artery disease (CAD) in different age groups. 99Tcm-MIBI SPET (stress-rest), EBCT and coronary angiography studies were performed in 64 consecutive patients with suspected CAD. The patients were classified into two groups: Group A = 40 patients > 45 years of age and Group B = 24 patients < or = 45 years of age. There were 31 and 14 patients with coronary stenosis > or = 50% as determined by coronary angiography in Groups A and B, respectively. All patients (30 cases) with abnormal 99Tcm-MIBI myocardial SPET and coronary calcification detected by EBCT had significant coronary artery disease, and 93.3% of the patients with normal 99Tcm-MIBI SPET and normal EBCT had normal coronary angiography or < 50% lumen narrowing of the coronary arteries. In Group B, the sensitivity of SPET for detecting CAD was significantly higher than that of EBCT (92.9 vs 42.9%, P < 0.01); the specificity of SPET was comparable to that of EBCT. In Group A, there was no significant difference between SPET and EBCT in terms of sensitivity (93.6 vs 90.3%) or specificity (88.9 vs 55.6%). However, in the detection of individual coronary artery disease, the specificity of SPET was significantly higher than that of EBCT in Group A (94.1 vs 66.7%, P < 0.001). The sensitivity of SPET was again significantly higher than that of EBCT (85.7 vs 38.1%, P < 0.005) in Group B. The accuracy of SPET was higher than that of EBCT in both groups (82.5 vs 67.5%, P < 0.01 in Group A; 93.1 vs 76.4%, P < 0.01 in Group B, respectively). We conclude that 99Tcm-MIBI myocardial perfusion SPET has a higher sensitivity than EBCT in the detection of CAD in patients < or = 45 years old and a higher specificity in patients > 45 years of age. A combination of SPET and EBCT may assess CAD more accurately.     

Combined functional and morphological imaging consisting of gated myocardial perfusion SPECT and 16-detector multislice spiral CT angiography in the noninvasive evaluation of coronary artery disease: first experiences

INTRODUCTION: Appropriate diagnosis and therapy of coronary artery disease (CAD) frequently require information about both the functional and morphological status of the coronary artery tree. We hypothesized that the combination of multislice spiral CT (MDCT) angiography and myocardial perfusion SPECT (MPI) provides accurate allocation of perfusion defects (PD) to their determining coronary lesion. METHODS: Twenty patients (14 male, mean age 64+/-9.2 years) with known CAD were retrospectively studied. Gated MPI, CT angiography using a 16-detector CT scanner, and conventional coronary angiography (CCA) were performed in each patient. Reversible and fixed PD were subsequently allocated to their determining lesion separately by different observers for MDCT angiography and CCA. RESULTS: All patients showed significant CAD in CCA; six patients with one-, six with two-, six with three-, and two with four-vessel disease; three patients had bypass grafts; and five patients had prior myocardial infarction. Correct diagnosis of CAD was stated in 14 of 20 patients by MDCT angiography. Five reversible and five fixed PD were detected in 9 of 20 patients; one patient showed both reversible and fixed PD. Five of five reversible PD could be allocated to appropriate coronary artery stenoses in CCA. In MDCT angiography, five of five reversible PD were allocated to the same lesions; all lesions were rated as >/=50%. CONCLUSIONS: The preliminary results of the present study show high accuracy for multislice spiral CT angiography to allocate reversible perfusion defects in myocardial scintigraphy to their determining coronary artery lesions in a small patient collective with known coronary artery disease.