Impact of attenuation correction by simultaneous emission/transmission tomography on visual assessment of 201Tl myocardial perfusion images.
Impact of attenuation correction by simultaneous emission/transmission tomography on visual assessment of 201Tl myocardial perfusion images.
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发表时间：
1999-08
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通讯作者：
R. Vidal;I. Buvat;J. Darcourt;O. Migneco;P. Desvignes;M. Baudouy;F. Bussière
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作者：
R. Vidal;I. Buvat;J. Darcourt;O. Migneco;P. Desvignes;M. Baudouy;F. Bussière
临床研究表明，对于冠状动脉疾病（CAD）可能性较低的受试者，衰减校正（AC）可提高下壁（右冠状动脉[RCA]区域）缺陷检测的特异性。本研究旨在研究AC对CAD患者RCA和前间隔（对应于左前降支[LAD]）区域视觉判读的影响。方法对五十六例疑诊冠心病的患者进行201 Tl放射/99 mTc同步显像。使用最大似然-期望最大算法重建图像，无AC和有AC。由3名经验丰富的医生盲解负荷/4 h延迟图像中RCA和LAD区域的可逆性或固定性缺损。冠状动脉造影，心电图和酶的结果被用来建立诊断缺血或梗死，并进行受试者工作特征（ROC）分析。结果ROC曲线面积的统计检验表明，在RCA区域，与不使用AC的性能相比，使用AC的缺陷检测性能有所改善。这主要是由于相似灵敏度（灵敏度值无明确变化）的特异性系统性增加12%或更多（对于任何观察者和任何类型的缺损）。然而，由于灵敏度系统性降低20%或更多，AC图像在LAD区域的缺陷检测性能显著降低（P < 0.05），特异性没有一致的变化。当分别考虑可逆和固定缺陷时，观察到类似的趋势。结论AC显著影响201 Tl负荷/4 h延迟SPECT图像的视觉判读。该研究证实了在RCA区域中AC获得的特异性增加。然而，在所考虑的人群中，研究的AC对LAD区域评估是有害的。
UNLABELLED It has been shown in clinical studies that for subjects with a low likelihood of coronary artery disease (CAD), attenuation correction (AC) improves the specificity of defect detection in the inferior wall (right coronary artery [RCA] region). The aim of this study was to investigate the effect of AC on the visual interpretation of the RCA and anteroseptal (corresponding to the left anterior descending artery [LAD]) regions in CAD patients. METHODS Fifty-six patients with suspected CAD underwent 20Tl stress/4 h-delayed imaging SPECT using a simultaneous 201Tl emission/99mTc transmission imaging protocol. Images were reconstructed using the maximum likelihood-expectation maximum algorithm without and with AC. The stress/4 h-delayed images were interpreted blindly for reversible or fixed defects in the RCA and LAD regions by three experienced physicians. Coronary angiography, electrocardiography and enzyme findings were used to establish diagnoses of ischemia or infarction, and receiver operating characteristic (ROC) analyses were performed. RESULTS Statistical testing of ROC curve areas showed that defect detection performance improved with AC when compared with performance without AC in the RCA region. This was mainly the result of a systematic increase in specificity of 12% or more (for any observer and any type of defect) for a similar sensitivity (no definite change in sensitivity values). However, defect detection performance significantly decreased in the LAD territory with AC images (P < 0.05) because of a systematic decrease in sensitivity of 20% or more, with no consistent change in specificity. Similar trends were observed when reversible and fixed defects were considered separately. CONCLUSION AC significantly affects the visual interpretation of 201Tl stress/4 h-delayed SPECT images. This study confirmed the increase in specificity obtained with AC in the RCA territory. However, in the population considered, the studied AC was deleterious for the LAD territory assessment.