静息/负荷82Rb PET门控心肌灌注显像定量分析的价值

目的 探讨门控和定量分析技术在82Rb PET心肌灌注显像中的应用价值.方法 对32例临床可疑冠心病患者进行静息/腺苷负荷82Rb PET门控心肌灌注显像.原始数据按常规处理成断层图像,再应用定量分析软件Emory Cardiac Toolbox(ECTb)进行定量分析.由3位有经验的核医学科医师分别对图像质量(优、良、一般、差、无法分析)、左心室射血分数(LVEF)的可信程度(同意、基本同意、不确定、基本不同意、不同意)、左心室功能的其他指标对诊断的价值(很有帮助、有帮助、不确定、基本无帮助、无帮助)进行评价.将观察指标分为肯定组和否定组,分别计算其百分率和90%可信区间.结果 192组分析结果中,图像质量优良者共计160组,占83.3%(160/192),其95%可信区间为78.1%～88.6%;图像质量为一般和差的共计32组,占16.7%(32/192),其95%可信区间为11.4%～21.9%.对LVEF的结果表示同意和基本同意者共计164组,占85.4%(164/192),其95%可信区间为80.4%～90.4%;认为不确定和基本不同意或不同意者共计28组,占14.6%(28/192),其95%可信区间为9.6%～19.6%.应用定量分析软件获得的除LVEF以外左心室功能的其他指标,认为很有帮助和有帮助者共计102组,占53.1%(102/192),其95%可信区间为46.1%～60.2%;不确定和基本无帮助或无帮助者90组,占46.9%(90/192),其95%可信区间为39.8%～53.9%.结论 门控和定量分析技术有助于PET图像阅片者作出更正确的诊断.

Diagnostic value of rest and stress gated 82Rb PET myocardial perfusion imaging using quantitative software

Objective Gated myocardial perfusion imaging (MPI) is regularly performed using SPECT. More recently, gated 82Rb MPI has been used to assess left ventricular myocardial perfusion and function with new generation PET scanners. The objective of this study was to evaluate the value of rest and stress gated 82 Rb PET myocardial perfusion imaging and to determine whether the quantitative technique increased the confidence level of the interpreters. Methods Thirty-two patients underwent rest and adenosine stress gated 82Rb PET MPI. Emory Cardiac Toolbox quantitative software was used for processing and interpretation. Left ventricular ejection fraction (LVEF), end-diastolic, end-systolic and transient ischemia dilation ratio were automatically generated. Three interpreters (nuclear medicine doctors) independently reviewed the studies. Visual scoring (1 - 5 scales : excellent, good, unsure, poor, uninterpretable) was used to assess the overall quality of the gated images and the added confidence level of interpretation. Visual assessment of the LVEF was compared to the automatically generated LVEF. Comparison between the visual assessment and software generated was graded on a 1- 5 scales (helpful, probably helpful, unsure, probably not helpful, definitely not helpful). The analysed items were divided into two groups (favorable group and negative group). The percentage and 95% confidence intervals of each group were calculated. Results A total of 192 gated studies were evaluated (64 gated × 3 interpreters). The overall quality of the gated images was good [excellent 40.1% (77/192) , good 43.2% (83/192), unsure 3.1% (6/192), poor 13.6% (26/192), uninterpretable 0]. The 95% confidence intervals of good and excellent quality range from 78.1% to 88.6%. The interpreters agreed with the automated LVEF on 85.4% of the gated images [agree 76.6% (147/192), probably agree 8.8% (17/192), unsure 3.1% (6/192), probably disagree 8. 8% (17/192), disagree 2.6% (5/192)]. And its 95% confidence intervals range from 80.4% to 90. 4%. Moreover, the functional information provided additional confidence for image interpretation [helpful 25.0% (48/192), probably helpful 28. 1% (54/192), unsure 2.6% (5/192), probably not helpful 15.1% (29/192), definitely not helpful 29.2% (59/192)]. The 95% confidence intervals of regarding the functional information as helpful and probably helpful range from 46.1% to 60.2%. Conclusion Rest and stress gated sz Rb PET myocardial perfusion imaging and quantitative software are helpful to the interpreters in their diagnosis of coronary artery disease.