- 期刊
Imaging Performance of Stress/Delayed Tl-201 ECG-Gated SPECT (GSPECT) in an Asian Population: A Comparative Study of Rest/Stress Tc-99m Sestamibi (MIBI) GSPECT
Tl-201心電圖閘門單光子斷層掃描使用在亞洲族群的表現：與Tc-99m sestamibi (MIBI)心電圖閘門單光子斷層掃描的比較
摘要
Background: We investigated the differences of perfusion and functional parameters obtained from Tl-201 and Tc-99m sestamibi (MIBI) myocardial perfusion electrocardiogram (ECG)-gated single photon emission computed tomography (GSPECT) in an Asian population. Methods: Two matched groups of 60 low-likelihood coronary artery disease (CAD) patients (LL group) (male = 56, female = 64; age = 46.0 ± 8.8 years; body mass index (BMI) = 25.9 ± 3.2 kg/m^2) and a group of 60 known CAD patients (CAD group) (male = 47, female = 13; age = 62.2 ± 11.7 years; BMI = 26.1 ± 3.3 kg/m^2) were recruited. The LL groups underwent either Tl-201 or MIBI myocardial perfusion GSPECT while the CAD group received both examinations within 10 days. Perfusion image data obtained from the Tl-201 and MIBI LL groups were employed to construct simplified gender-tracer-specific normal databases with a commercially available program quantitative perfusion SPECT/quantitative gated SPECT (QPS/QGS). Perfusion scores for the CAD group were derived from normal databases. Perfusion scores, transient ischemic dilation (TID) ratio and change of left ventricular ejection fraction (ΔLVEF = stress LVEF - rest LVEF) were assessed to determine the differences between two imaging methods for an Asian population. Results: Excessively small left ventricles resulted in 10 outliers in Tl-201 LL group and 5 outliers in the known CAD group for LVEF evaluation. All the outliers came from the Tl-201 studies. The TID ratio (1.02 ± 0.1 vs. 1.05 ± 0.1; p = 0.106) and ΔLVEF (-0.04 ± 6.53% vs. -1.43 ± 4.31%; p = 0.183) were comparable between the Tl-201 and MIBI LL groups. Summed stress score (SSS) (8.81 ± 8.93 vs. 9.05 ± 8.45; p = 0.561), summed rest score (SRS) (5.12 ± 6.97 vs. 5.50 ± 6.73; p = 0.229) and summed difference score (SDS) (5.12 ± 6.97 vs. 5.50 ± 6.73; p = 0.229) in the known CAD group were similar with comparable TID (1.08 ± 0.17 vs. 1.11 ± 0.09; p = 0.115) and slightly different ΔLVEF (-0.44 ± 8.01 vs. -3.16 ± 3.98; p = 0.011). Receiver operating characteristics revealed analogous area under curve for TID (0.76 vs. 0.74; p = 0.90) and ΔLVEF (0.70 vs. 0.73; p = 0.80) for predicting severe CAD (SDS ≥ 8). Conclusions: In this Asian population, perfusion scores, TID ratio and ΔLVEF obtained from Tl-201 and MIBI GSPECT were similar. Tl-201 GSPECT particularly failed to evaluate LVEF for patients with excessively small left ventricles.
並列摘要
背景：本研究探討Tl-201與Tc-99m sestamibi (MIBI)心電圖閘門單光子斷層掃描使用在亞洲族群，在心肌灌注、暫時性缺氧擴張及收縮功能的評估上是否有差異。方法：本研究共收案兩組低心血管疾病風險之受檢者各60人（男性56人，女性64人；年齡46 ± 8.8歲；身體質量指數25.9 ± 3.2 kg/m^2）及一組已知有心血管疾病之受檢者60人（男性47人，女性13人；年齡62.2 ± 11.7歲；身體質量指數26.1 ± 3.3 kg/m^2）。低心血管疾病風險之受檢者接受Tl-201或Tc-99m MIBI心電圖閘門單光子斷層掃描，而已知有心血管疾病之受檢者則在10天內接受這兩種檢查。將低心血管疾病風險組的掃描結果輸入電腦軟體quantitative perfusion SPECT/quantitative gated SPECT (QPS/QGS)產生正常資料庫。已知有心血管疾病組的掃描結果，與正常資料庫比對，得出心肌灌注積分。用心肌灌注積分、暫時性缺氧擴張及左心室收縮差（壓力態之左心室收縮減去休息態之左心室收縮）來評估這兩種藥物之心電圖閘門單光子斷層掃描使用在亞洲族群之差異。結果：由於心臟太小，低心血管疾病風險組有10個受檢者，已知有心血管疾病組有5個受檢者被判定為異常值，其左心室功能無法評估，且這些異常值都只出現在Tl-201心電圖閘門單光子斷層掃描。在低心血管疾病風險組，Tl-201及Tc-99m MIBI的暫時性缺氧擴張(1.02 ± 0.1 vs. 1.05 ± 0.1; p = 0.106)及左心室收縮差(-0.04 ± 6.53% vs. -1.43 ± 4.31%; p = 0.183)並無顯著差異。在已知有心血管疾病組，summed stress score (SSS) (8.81 ± 8.93 vs. 9.05 ± 8.45; p = 0.561)，summed rest score (SRS) (5.12 ± 6.97 vs. 5.50 ± 6.73; p = 0.229)及summed difference score (SDS) (5.12 ± 6.97 vs. 5.50 ± 6.73; p = 0.229)沒有差異，暫時性缺氧擴張也沒有差異，但左心室收縮差則是Tl-201略少於Tc-99m MIBI。接收者操作特徵曲線分析(receiver operating characteristic [ROC] curve)顯示在偵測嚴重心血管疾病(SDS ≥ 8)的能力上，不管針對暫時性缺氧擴張(0.76; 0.74 vs. p = 0.90)或是左心室收縮差(0.70 vs. 0.73; p = 0.80)，這兩種藥物都相當類似。結論：即使是在亞洲族群，Tl-201及Tc-99m MIBI的心肌灌注積分、暫時性缺氧擴張及左心室收縮差還是近似的。而Tl-201更容易遇到因為心臟較小，而無法評估左心室收縮功能的情形。