核醫心肌灌注掃描檢查半定量參數和冠狀動脈疾病的相關性

Investigation of the relationship between the nuclear myocardial perfusion imaging semiquantitative parameters and coronary artery disease

劉芝庭(Chih-Ting Liu)

指導教授 ： 田育彰

高雄醫學大學/健康科學院/醫學影像暨放射科學系碩士在職專班/碩士(2019年)

摘要

背景與目的:本研究為探討核醫心肌灌注掃描(MPI)獲得之半定量分析參數，並分析這些參數與冠狀動脈疾病(CAD)相關的程度。
材料與方法:自2017年1月到12月間，共有1685例接受MPI之受檢者，其中130例在3個月內有進行心導管檢查。分析這130例MPI之半定量分析參數與心導管結果做比較，利用ROC曲線算出各個半定量參數的最佳切點，找出敏感度和特異度最好之參數，並比較此參數之最佳切點數值是否會因受檢者的條件不同而有所差異。此外將研究所獲得之閾值與本院現行之閾值做比較分析。
結果: ROC曲線分析中，stress TPD最佳切點有最大的AUC面積(81.3%)及靈敏度(73.5%)，為最具鑑別力之半定量參數。若以受檢者的不同條件分組計算stress TPD，其最佳切點會因條件不同而有所差異，但各分組之最佳切點對於CAD之靈敏度及特異度並無提升。本研究所算出之閾值為3.5%與原先現行之閾值為5%比較，其靈敏度分別為73.5%及61.4%，當閾值為3.5%時對於CAD的診斷會更靈敏。
結論:以本研究所算出之stress TPD閾值搭配本院現行的影像收集條件,是鑑別冠狀動脈疾病較好的診斷工具。

關鍵字

心肌灌注掃描 ； 冠狀動脈疾病 ； stress TPD

並列摘要

Purpose: This study aimed to investigate the diagnostic performance of myocardial perfusion imaging(MPI) semiquantitative parameters for coronary artery disease(CAD).
Material and methods: A total of 1685 patients underwent MPI from January to December 2017, and 130 received invasive coronary angiography within three months after MPI. The invasive coronary angiography was used as the reference standard to compare these semiquantitative parameters in MPI. Receiver operating characteristics (ROC) analysis was used to determine the optimal cut-off point of these parameters and indicated which parameter had the highest value of the area under the curve (AUC). The best cut point values were to be change or not depending on whether the patients had different conditions.
Result: The optimal cut-off point of stress total perfusion deficit(sTPD) had the highest value of the AUC (=0.813) and maximum sensitivity values (= 73.5%) for the diagnosis of CAD in these parameters. Although socio-demographic and clinical details of these patients were retrieved for further analysis in sTPD, the sensitivity and specificity of each subgroup went to a similar result. The threshold was 5% for sTPD in our hospital and 3.5% for sTPD as established in130 patients resulting in sensitivity of 61.4% and 73.5% respectively. The latter threshold as for the sTPD could improve the diagnosis of CAD.
Conclusion: In this study, sTPD may be a suitable parameter in detection of CAD under current image acquisition in our hospital.

並列關鍵字

Myocardial perfusion imaging ； Coronary artery disease ； Stress total perfusion deficit

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