腺苷心肌灌注断层显像诊断老年人冠心病的价值

目的 探讨腺苷负荷试验锝-甲氧基异丁基异腈(~(99m)Tc-MIBI)心肌灌注单光子发射计算机断层显像(ECT)诊断老年人冠心病的价值. 方法 53例无心肌梗死病史的老年冠心病待查患者,年龄60～78岁,平均(65.5±6.5)岁.将ECT和冠状动脉造影(CAG)结果进行对照. 结果 ECT对CAG阳性冠心病诊断的敏感性为73.7%,特异性90.9%,阳性预测值为94.3%,阴性预测值为80.0%,准确性指数为62.3%.结果显示,腺苷ECT对左前降支、回旋支、右冠状动脉检出的特异性分别为90.9%、85.7%、100%,阳性预测值分别为73.5%、77.3%、72.0%. 结论 腺苷是一种较强的血管扩张剂,对心血管系统有多重作用.其与导管技术、核素心肌灌注显像等技术结合可用于冠心病的诊断.腺苷介入心肌灌注断层显像是一种无创、方便、费用低的检查方法,对老年冠心病的诊断、指导治疗和判断预后有重要的意义.     

ATP负荷 99mTc-MIBI门控心肌SPECT显像在冠状动脉临界病变危险分层中的价值

目的探讨三磷酸腺苷(ATP)负荷99m锝-甲氧基异丁基异腈(~(99m)Tc-MIBI)门控心肌单光子发射计算机断层显像(SPECT)在评价冠状动脉临界病变危险分层中的价值。方法选择100例以冠状动脉造影明确诊断为冠状动脉临界病变的患者,行ATP负荷~(99m)Tc-MIBI门控心肌SPECT显像检查,将左心室心肌短轴和垂直长轴像划分为17个节段,采用视觉半定量评价法评价各心肌节段核素分布情况,计算左心室负荷总积分(SSS)、左心室静息总积分(SRS)、左心室总积分差(SDS),统计缺血节段数,根据SSS值和缺血节段数对患者进行危险分层;分析冠状动脉临界病变患者的危险分层及心肌缺血程度;探究冠状动脉临界病变狭窄程度与心肌缺血及危险分层的相关性。结果 100例冠状动脉临界病变患者,其中单支病变患者62例,双支病变患者33例,三支病变患者5例。对临界病变患者进行危险分层:低危组45例(45.0%),中危组34例(34.0%),高危组21例(21.0%)。多支病变组高危患者比例高于单支病变组,多支病变组SSS和SDS值也高于单支病变组(P0.05),而SRS值无明显差异。所有患者共累及143支冠状动脉临界病变,其中左前降支84支,左回旋支29支,右冠状动脉30支,三组之间SSS值、SDS值、SRS值无明显差异(P0.05)。冠状动脉临界病变患者中,轻度狭窄患者与中度狭窄患者间低、中、高危患者的分布无明显差异。冠状动脉狭窄程度与SSS、SRS及SDS间无相关关系。ATP负荷~(99m)Tc-MIBI门控心肌SPECT显像对冠状动脉临界病变患者心肌缺血检出率显著高于动态心电图检出率(76.0%比39.0%,P0.05)。结论ATP负荷~(99m)Tc-MIBI门控心肌SPECT显像可以较准确地对冠状动脉临界病变患者进行危险分层,指导临床治疗。     

~(99m)Tc-MIBI心肌断层显像在心脏疾病诊治中的临床价值

随着医学科学的不断发展,心血管疾病的诊断手段日趋完善,但每一种检查方法都有一定的局限性。核素心肌显像是近年来新兴的非创伤性重要的检查手段。~(99m)Tc-MIBI心肌断层显像在冠心病的诊断及冠心病的治疗疗效判断具有特殊的临床价值,对冠心病诊断特异性及准确性较高,对其它心肌病变的心脏性疾病的诊断也有一定的临床价值,现将~(99m)Tc-MIBI心肌断层显像在心脏疾病诊治中的临床应用综述如下。     

硝酸甘油99mTc-甲氧基异丁基异晴心肌灌注显像技术对冠心病诊断及其估测心肌存活性的价值

目的评价硝酸甘油99mTc-甲氧基异丁基异晴(MIBI)心肌灌注显像技术对冠心病的诊断及其估测心肌存活性的价值。方法48例可疑冠心病患者,于冠状动脉造影(CAG)术前1周内行静息、硝酸甘油介入99mTc-MIBI心肌灌注显像(SPECT)检查,以CAG为金标准,观察SPECT诊断冠心病的准确性。对于25例成功行经皮冠脉介入治疗(PCI)的冠心病患者,以PCI术后3个月室壁运动改善为检验标准,评价SPECT检测存活心肌的应用价值。结果SPECT诊断冠心病的敏感性、特异性和准确性分别为86.7%、72.2%和81.3%,评价存活心肌的敏感性为91.8%,准确性为84.9%。结论硝酸甘油99mTc-MIBI心肌灌注显像技术在诊断冠心病及其估测心肌存活性方面有较高的临床应用价值。     

腺苷负荷试验心肌灌注显像诊断冠心病的临床价值

目的　评价腺苷负荷试验心肌灌注显像诊断冠心病的准确性。方法　对 89例临床疑诊冠心病患者 ,分别静脉注射腺苷 ,剂量为 14 0 μg·kg-1·min-1,用药时间 6min(总剂量为 0 8mg/kg) ,注射过程中 ,行心电监测 ,观察患者的症状、血压和心率 ,于注射腺苷 3min末 ,静脉注射核素显像剂99mTc MIBI 92 5MBq ,1h后行心肌灌注断层显像 ,若显像异常 ,次日行静息心肌显像。所有患者行冠状动脉造影。结果　在 89例患者中 ,31例冠状动脉造影显示明显的冠状动脉狭窄病变 ,其中单支病变 10例 ,二支病变 11例 ,三支病变 10例。累及左前降支 2 8支 ,左回旋支 18支 ,右冠状动脉 16支 ,左主干 2支。腺苷负荷试验心肌灌注显像诊断冠心病的敏感性为 71%、特异性为 91%、阳性预测值81%、阴性预测值 84 %、准确性为 84 %。诊断单支、二支和三支冠状动脉病变患者的敏感性分别为5 0 %、73%、90 %。腺苷负荷试验心肌灌注显像判断血管病变的敏感性 77%、特异性 96 %、准确性 92 %。结论　腺苷负荷心肌灌注显像诊断冠心病敏感性及特异性均较高 ,具有重要的临床应用价值。     

多层螺旋CT冠状动脉成像的临床应用

目的:评价多层螺旋CT冠状动脉造影(MSCTA)在冠状动脉病变中的诊断意义。方法:108例老年患者行MSCTA,记录冠状动脉钙化的部位及钙化积分、冠状动脉狭窄的部位及支数,同期进行动态和静息单光子发射计算机断层核素心肌灌注显像(SPECT)及选择性冠状动脉血管造影术,以冠状动脉血管造影检查为金标准,将检查结果逐一对照,并进行统计学分析。结果:MSCTA检查诊断冠心病的敏感性、特异性、阳性预测值、阴性预测值及准确性分别为77%,72%,88%,54%,76%;诊断单支、2支、和3支冠状动脉病变的敏感性分别为63%、91%、96%;与SPECT检查联合评价,诊断冠心病的敏感性、特异性、阳性预测值、阴性预测值可提高到99%、93%、96%、94%;冠状动脉钙化积分随危险因素及冠状动脉病变累及的支数增多而增加,对≥65岁男性患者,冠状动脉钙化积分≥200意义较大。结论:MSCTA可一次性完成冠状动脉钙化积分和狭窄评价,对评价冠状动脉狭窄有一定的价值,尤其结合SPECT可明显提高诊断的正确性,可作为冠状动脉血管造影术术前筛选的常规无创性检查方法。     

~(99m)Tc-MIBI SPECT/CT显像联合超声对继发性甲状旁腺功能亢进症患者甲状腺内异位甲状旁腺的术前定位

目的探讨~(99m)Tc-甲氧基异丁基异腈(Tc-99m methoxyisobutylisonitrile,~(99m)Tc-MIBI)单光子发射计算机断层扫描/计算机断层扫描(single-photon emission computed tomography/computed tomography,SPECT/CT)显像联合超声对继发性甲状旁腺功能亢进症(hyperparathyroidism,HPT)术前异位病灶的定位诊断价值。方法回顾2013年9月至2018年12月经东南大学医学院附属江阴医院手术及病理证实的67例继发性HPT患者的影像资料,由多学科团队分析甲状腺内异位甲状旁腺(ectopic intrathyroid parathyroid gland,ETPG)的~(99m)Tc-MIBI SPECT/CT显像及超声表现。结果 67例患者中,3例经术中探查和术后病理证实为ETPG,其中ETPG异位于右侧甲状腺内1枚,异位于左侧甲状腺内2枚。术前~(99m)Tc-MIBI SPECT/CT显像检出2枚;经多学科讨论后由经验丰富的超声医师二次检查后检出1枚; 1枚ETPG并发同侧结节性甲状腺肿~(99m)Tc-MIBI SPECT/CT显像及超声均漏诊,该例还并发甲状腺微小乳头状癌,术前由超声检出。结论联合应用~(99m)TcMIBI SPECT/CT显像及超声对ETPG有较好的术前定位诊断价值,建立长期密切协作的多学科合作模式有助于提高ETPG的定位准确性。     

潘生丁—~(99m)锝—MIBI单光子发射型计算机心肌断层显像在冠心病中的诊断价值

本文分别比较了潘生丁—~(99m)锝—MIBI单光子发射型计算机心肌断层显像,~(99m)锝—MIBI运动心肌断层显像与~(201)铊运动心肌断层显像在冠心病中的诊断价值。结果表明:以冠状动脉造影结果为依据,潘生丁—~(99m)锝—MIBI心肌断层显像对冠心病的诊断价值与~(201)铊运动心肌断层显像相似,而~(99m)锝—MIBI运动心肌断层显像却劣于~(201)铊。因此,潘生丁—~(99m)锝—MIBI心肌断层显像是冠心病诊断中一种安全而灵敏的心肌核素显像方法。     

~(99m)Tc-MIBI SPECT/CT显像联合超声对继发性甲状旁腺功能亢进症患者甲状腺内异位甲状旁腺的术前定位

目的探讨~(99m)Tc-甲氧基异丁基异腈(Tc-99m methoxyisobutylisonitrile,~(99m)Tc-MIBI)单光子发射计算机断层扫描/计算机断层扫描(single-photon emission computed tomography/computed tomography,SPECT/CT)显像联合超声对继发性甲状旁腺功能亢进症(hyperparathyroidism,HPT)术前异位病灶的定位诊断价值。方法回顾2013年9月至2018年12月经东南大学医学院附属江阴医院手术及病理证实的67例继发性HPT患者的影像资料,由多学科团队分析甲状腺内异位甲状旁腺(ectopic intrathyroid parathyroid gland,ETPG)的~(99m)Tc-MIBI SPECT/CT显像及超声表现。结果 67例患者中,3例经术中探查和术后病理证实为ETPG,其中ETPG异位于右侧甲状腺内1枚,异位于左侧甲状腺内2枚。术前~(99m)Tc-MIBI SPECT/CT显像检出2枚;经多学科讨论后由经验丰富的超声医师二次检查后检出1枚; 1枚ETPG并发同侧结节性甲状腺肿~(99m)Tc-MIBI SPECT/CT显像及超声均漏诊,该例还并发甲状腺微小乳头状癌,术前由超声检出。结论联合应用~(99m)TcMIBI SPECT/CT显像及超声对ETPG有较好的术前定位诊断价值,建立长期密切协作的多学科合作模式有助于提高ETPG的定位准确性。     

~(99)Tcm-MIBI SPECT心肌灌注显像与磁共振成像心肌灌注延迟增强诊断冠心病的对比研究

目的评价99 Tcm-MIBI SPECT心肌灌注显像与磁共振成像心肌灌注延迟增强(DE-MRI)诊断冠心病(CAD)的临床价值,并比较两种方法的相关性。方法 72例临床诊断CAD病人,进行99 Tcm-MIBI SPECT心肌灌注显像、DE-MRI及冠状动脉造影(CAG)。左心室心肌节段划分采用17节段法,连续两个心肌节段灌注显像异常作为诊断CAD的标准,左心室各节段心肌延迟增强分级标准分为5级,1级~4级作为诊断CAD的标准,以CAG结果冠状动脉狭窄≥50%作为诊断CAD的金标准。结果 72例病人中经CAG诊断为CAD 61例,非CAD 11例;以CAG结果作为诊断CAD的金标准,99 Tcm-MIBI SPECT心肌灌注显像诊断CAD的灵敏性、特异性、准确性分别是88.5%、63.6%、84.7%;DE-MRI诊断CAD的灵敏性、特异性、准确性分别是78.7%、81.8%、79.2%。两种方法诊断CAD相关性良好。结论 99 Tcm-MIBI SPECT心肌灌注显像和DE-MRI诊断CAD具有较高的临床价值,二者相关性较好。     

99mTc-MIBI门电路SPECT对冠心病的诊断和心肌存活性评价的作用

为进一步评价99m锝-甲氧基异睛(99mTc-MIBI)门电路和非门电路单光子发射断层显像(SPECT)对冠心病的诊断价值及硝酸甘油介入诊断试验在心肌存活状态评价中的作用,对40例进行运动心肌灌注断层显象,并与冠状动脉(冠脉)造影比较.结果32例冠脉造影显示冠脉有意义狭窄.门电路断层显象对冠心病诊断总的敏感和特异性分别为93.8%和87.5%;非门电路断层显象分别为84.4%和87.5%,两相比较,无显著性差异(P＞0.05).对冠脉病变支数诊断敏感性门电路方法优于非门电路方法(分别为73.8%和62.3%,P＜0.05).特异性均为96.6%.20例进行含服硝酸甘油后静态心肌灌注断层显象,16例心肌梗死病人中有3例为部分可逆性心肌灌注缺损,4例慢性心肌缺血病人,全部有可逆性心肌灌注.表明硝酸甘油介入诊断试验有助于心肌灌注异常可逆性的评估;99mTc-MIBI门电路SPECT和硝酸甘油介入诊断试验是有效的对冠心病无创性诊断和心肌存活状态评价方法.     

Comparison of electrocardiographic-gated technetium-99m sestamibi single-photon emission computed tomographic imaging and rest-redistribution thallium-201 in the prediction of myocardial viability

Although the combined assessment of perfusion and function using rest electrocardiographic (ECG)-gated technetium-99m (Tc-99m) sestamibi single-photon emission computed tomographic (SPECT) imaging has been shown to improve sensitivity and accuracy over perfusion alone in the prediction of myocardial viability, no data are available comparing this technique with rest-redistribution thallium-201. Thirty patients with coronary artery disease and left ventricular dysfunction (ejection fraction < or = 40%) underwent rest-redistribution thallium-201 and rest ECG-gated Tc-99m sestamibi SPECT imaging before revascularization and rest ECG-gated Tc-99m sestamibi SPECT imaging at 1 or 6 weeks after revascularization. All thallium-201 and Tc-99m sestamibi images were interpreted by a consensus agreement of 3 experienced readers without knowledge of patient identity or time of imaging with Tc-99m sestamibi (before or after revascularization) using a 17-segment model. Concordance between techniques for the prediction of viability was 89% (kappa 0.556 +/- 0.109). With rest-redistribution thallium-201, sensitivity, specificity, positive predictive value, negative predictive value, and predictive accuracy were 95%, 59%, 88%, 78%, and 86%, respectively. With rest ECG-gated Tc-99m sestamibi SPECT imaging, sensitivity, specificity, positive predictive value, negative predictive value, and predictive accuracy were 96%, 55%, 87%, 80%, and 86%, respectively (p = NS vs rest-redistribution thallium-201). Although both techniques are comparable for detecting viable myocardium, rest ECG-gated Tc-99m sestamibi SPECT imaging allows direct assessment of both myocardial perfusion and ventricular function, which may be clinically useful in patients who require assessment of myocardial viability.     

Dipyridamole stress echocardiography and ultrasonic myocardial tissue characterization in predicting myocardial ischemia, in comparison with dipyridamole stress Tc-99m MIBI SPECT myocardial imaging

The purpose of this study was to validate whether dipyridamole stress ultrasonic tissue characterization with cyclic variation of integrated backscatter (CVIBS) compared with dipyridamole stress echocardiography and dipyridamole stress Tc99m-MIBI SPECT myocardial perfusion scintigraphy could predict myocardial ischemia in patients with chronic coronary artery disease. Twenty patients (16 M, 4 F) who had coronary angiography for stable angina pectoris were included in the study. Mean age was 62 +/- 8 years. The left ventricle was divided into 16 segments. Regional wall motion analysis and CVIBS measurements were obtained from 16 myocardial segments at rest and after dipyridamole (0.84 mg/kg) infusion. After 10 minutes, Tc-99m MIBI (10 mCi) was injected and SPECT myocardial imaging was performed. After 3 hours, 25 mCi Tc-99m MIBI was reinjected and rest images were obtained. A total of 320 ventricular wall segments were evaluated. Two hundred and six ventricular wall segments were supplied by stenotic coronary arteries and 114 segments were supplied by normal coronary arteries. Dipyridamole stress Tc-99m MIBI SPECT studies showed abnormal myocardial perfusion in 176 segments and normal perfusion in 144 segments. Transient regional wall motion abnormality was detected in 116 segments. A significant decrease in CVIBS after dipyridamole stress was detected in 184 segments. The sensitivity and specificity of dipyridamole stress echocardiography, Tc-99m MIBI SPECT, and CVIBS were 56% and 100%, 85% and 92%, and 89% and 100%, respectively, compared with the results from coronary angiography. Dipyridamole stress ultrasonic tissue characterization with CVIBS may provide more sensitive detection of myocardial ischemia than dipyridamole stress echocardiography and may be as valuable as dipyridamole stress myocardial perfusion scintigraphy.     

~(99)Tc~m-MIBI心肌显像在检测“罪犯”血管中的作用

目的　评价 99Tcm -甲氧基异丁基异腈 (MIBI)心肌灌注断层 (SPECT)显像在检测“罪犯”血管中的作用。方法　选择冠状动脉造影证实有多支血管病变并成功进行经皮腔内冠状动脉成形术 (PTCA)血流重建治疗的冠心病患者 5 2例。PTCA术前进行运动、静息、静脉滴注硝酸甘油介入 99Tcm - MIBI心肌显像 ,明确缺血与存活心肌数量最多的部位 ,以对应支配该部位的病变血管确定为“罪犯”血管。以术后疗效为标准 ,验证其准确性。结果　 5 2例中 ,冠状动脉造影发现病变血管 12 5支 ,心肌显像确定“罪犯”血管 5 2支。临床对确定的“罪犯”血管进行相应的血流重建治疗 ,随访均有良好疗效。结论　运动、静息、静脉滴注硝酸甘油介入 99Tcm- MIBI心肌显像检测“罪犯”血管准确可靠 ,实用可行     

Myocardial perfusion imaging with technetium-99m sestamibi SPECT in the evaluation of coronary artery disease

Technetium-99m (Tc-99m) sestamibi is a new myocardial perfusion imaging agent that offers significant advantages over thallium-201 (Tl-201) for myocardial perfusion imaging. The results of the current clinical trials using acquisition and processing parameters similar to those for Tl-201 and a separate (2-day) injection protocol suggest that Tc-99m sestamibi and Tl-201 single photon emission computed tomography (SPECT) provide similar information with respect to detection of myocardial perfusion defects, assessment of the pattern of defect reversibility, overall detection of coronary artery disease (CAD) and detection of disease in individual coronary arteries. Tc-99m sestamibi SPECT appears to be superior to Tc-99m sestamibi planar imaging because the former provides a higher defect contrast and is more accurate for detection of disease in individual coronary arteries. Research is currently under way addressing optimization of acquisition and processing of Tc-99m sestamibi studies and development of quantitative algorithms for detection and localization of CAD and sizing of transmural and nontransmural myocardial perfusion defects. It is expected that with the implementation of the final results of these new developments, further significant improvement in image quality will be attained, which in turn will further increase the confidence in image interpretation. Development of algorithms for analysis of end-diastolic myocardial images may allow better evaluation of small and nontransmural myocardial defects. Furthermore, gated studies may provide valuable information with respect to regional myocardial wall motion and wall thickening. With the implementation of algorithms for attenuation and scatter correction, the overall specificity of Tc-99m sestamibi SPECT should improve significantly because of a substantial decrease in the occurrence of attenuation-related image artifacts.(ABSTRACT TRUNCATED AT 250 WORDS)     

Adenosine technetium-99m sestamibi myocardial perfusion SPECT in women: Diagnostic efficacy in detection of coronary artery disease

Objectives. This study sought to assess the diagnostic efficacy of adenosine technetium-99m (Tc-99m) sestamibi myocardial perfusion single-photon emission computed tomography (SPECT) in a consecutive series of female patients.Background. The utility of adenosine myocardial perfusion SPECT for the detection of coronary artery disease is not well defined in women because most studies have described a predominantly male population with a high prevalence of coronary artery disease.Methods. Of the 201 consecutive female patients in the study group who had undergone adenosine Tc-99m sestamibi myocardial perfusion SPECT, 130 had coronary angiography within 2 months of the nuclear test, and the other 71 had a low likelihood (<10%, mean [±SD] 5 ± 3%) of coronary artery disease. The SPECT protocol used separate acquisition of rest thallium-201 and adenosine Tc-99m sestamibi and was visually analyzed in 20 segments with a semiquantitative five-point scoring system (0 = normal; 4 = absent uptake).Results. The normaley rate in patients with a low likelihood of coronary artery disease was 93% (66 of 71). Among the catheterized group, the overall sensitivity, specificity and predictive accuracy of adenosine sestamibi SPECT for detecting coronary artery disease (⪰50% diameter stenosis) were 93% (87 of 94), 78% (28 of 36) and 88% (115 of 130), respectively. In the 103 patients without a prior myocardial infarction, the sensitivity, specificity and predictive accuracy were 91% (61 of 67), 78% (28 of 36) and 86% (89 of 103), respectively, for detecting ⪰50% diameter stenosis. Of particular interest, the sensitivity and specificity were as high in patients with nonanginal symptoms (93% and 69%, respectively) as in patients with angina (92% and 83%, respectively, p = NS). The sensitivity and specificity among patients with a relatively low (<25%), intermediate (between 25% and 75%) or high prescan likelihood of coronary artery disease (>75%) were similar: 82% and 82%, 93% and 73%, and 95% and 100%, respectively. The sensitivity and specificity for detecting individual diseased vessels (⪰50% diameter stenosis) were, respectively, 76% and 81% for the left anterior descending coronary artery, 44% and 90% for the left circumflex coronary artery and 75% and 77% for the right coronary artery.Conclusions. Adenosine Tc-99m sestamibi SPECT is an efficient protocol with high sensitivity and specificity for the detection of coronary artery disease in women irrespective of presenting symptoms or pretest likelihood of coronary artery disease and a high normaley rate. These findings are of particular clinical relevance because chest pain, anginal or otherwise, has been shown to be a frequent but a less specific marker for coronary artery disease among female patients.     

99mTc-CPI myocardial perfusion tomography for evaluation of coronary artery disease

Stress 99mTc-carbomethoxy isopropyl isonitrile myocardial perfusion tomography (Tc-CPI MPT) was performed in 24 controls with normal coronary arteriograms or stenosis less than 50% and 30 patients with coronary artery disease (CAD) (stenosis greater than 50%). The sensitivity and specificity for the detection of CAD with Tc-CPI MPI was 90% and 96% respectively. The sens by Tc-CPI MPI was 89% for the patients with one-vessel involvement, 88% for two-vessel involvement, 100% for three-vessel involvement. The sens for the detection of LAD, LCX and RCA involvement was 86%, 86% and 80% respectively. The spec were 100%, 100% and 91% respectively. It is concluded that TC-CPI MPT is a valuable technique for diagnosing CAD.     

Comparative ability of myocardial perfusion single-photon emission computed tomography to detect coronary artery disease in patients with and without diabetes mellitus

BACKGROUND: Diabetics generally have more frequent and extensive silent myocardial ischemia than nondiabetics, increasing the importance of noninvasive detection of coronary artery disease (CAD) in this cohort. However, little is known regarding the diagnostic accuracy of myocardial perfusion single-photon emission computed tomography (SPECT) in patients with diabetes. This study was undertaken to compare the diagnostic value of rest thallium-201/stress technetium-99m sestamibi dual-isotope myocardial perfusion SPECT in patients with and without diabetes. METHODS: Of the 203 patients with diabetes and 260 patients without diabetes who underwent dual-isotope myocardial perfusion SPECT with exercise or pharmacologic stress testing, 138 diabetics (12% type 1 diabetics) and 188 nondiabetics had coronary angiography within 6 months of the nuclear test, and 65 diabetics and 72 nondiabetics had a low likelihood (<10%, mean 6% +/- 3% and 6% +/- 3%) of CAD. RESULTS: The angiographic data showed that patients with diabetes had less incidence of 1-vessel disease and a higher incidence of 3-vessel/left main artery disease than patients without diabetes (P <.05). The overall sensitivity and specificity, respectively, of SPECT for detecting CAD with the criterion of >/=50% diameter stenosis were 86% (95 of 111) and 56% (15 of 27) in diabetics, 86% (122 of 142) and 46% (21 of 46) in nondiabetics (P = not significant). With the criterion of >/=70% diameter stenosis the corresponding results were 90% (86 of 96) and 50% (21 of 42) in diabetics, and 91% (108 of 119) and 43% (30 of 69) in nondiabetics, respectively (P = not significant). The normalcy rate for low likelihood patients was 89% (58 of 65) in diabetics and 90% (65 of 72) in nondiabetics (P = not significant). The sensitivity and specificity for individual vessel detection were also similar in patients with and without diabetes (P = not significant) except for a lower sensitivity and a higher specificity for detecting left anterior descending coronary artery disease in the diabetic group (P <.05). CONCLUSION: Dual-isotope myocardial perfusion SPECT has comparable accuracy for the diagnosis of CAD in diabetic and nondiabetic patients.     

Detection and assessment of unstable angina using myocardial perfusion imaging: comparison between technetium-99m sestamibi SPECT and 12-lead electrocardiogram

Forty-five studies using technetium-99m (Tc-99m) sestamibi single photon emission computed tomography (SPECT) were performed on patients hospitalized for spontaneous chest pain suggestive of myocardial ischemia. The studies were done after an injection during an episode of chest pain and a repeated injection when the patients were free of pain. All patients were hospitalized with a presumed diagnosis of unstable angina, and none had evidence of a previous myocardial infarction. The presence of a perfusion defect observed with Tc-99m sestamibi injected during chest pain had a 96% sensitivity and a 79% specificity for the detection of significant coronary artery disease (stenosis greater than or equal to 50%) on subsequent angiography. When the criterion of a larger perfusion defect during pain compared to absence of pain was used, the sensitivity was 81% and the specificity was 84%. In contrast, transient electrocardiographic ischemic changes during pain had a sensitivity of 35% and a specificity of 68%; electrocardiographic changes during or outside episodes of chest pain had a sensitivity of 65% and a specificity of 63% for the diagnosis. Tc-99m sestamibi SPECT represents a reliable noninvasive diagnostic tool that could aid in the diagnosis of myocardial ischemia in patients with spontaneous chest pain and provide additional information to that provided by the electrocardiogram.