Quantitative assessment of myocardial perfusion abnormality on SPECT myocardial perfusion imaging is more reproducible than expert visual analysis.
Quantitative assessment of myocardial perfusion abnormality on SPECT myocardial perfusion imaging is more reproducible than expert visual analysis.
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DOI：
10.1007/s12350-008-9018-0
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发表时间：
2009-01
影响因子：
2.4
通讯作者：
Germano, Guido
中科院分区：
文献类型：
--
作者：
Berman, Daniel S.;Kang, Xingping;Gransar, Heidi;Gerlach, James;Friedman, John D.;Hayes, Sean W.;Thomson, Louise E. J.;Hachamovitch, Rory;Shaw, Leslee J.;Slomka, Piotr J.;De Yang, Ling;Germano, Guido
目前美国食品和药物管理局在临床试验中评价SPECT心肌灌注成像(MPI)的指南建议由多名专家独立进行视觉解释。很少有研究涉及定量SPECT MPI评估是否更适用于这一应用。在第二个研究中，我们研究了31例(68±13)岁，男性25例，在9~22个月(平均14.9±3.8个月)内接受重复运动(n=11)或腺苷MPI(n=20)的MPI，无间歇性血管重建术或心肌梗死，症状、应激类型、静息或应激心电图或临床应激反应无变化。根据FDA指南，视觉解释使用由两个独立专家阅读器进行的17个节段的5分评分，并由第三名专家对不一致性进行超读，心肌异常百分比由标准化总分得出。血流灌注异常的定量程度由总的灌注缺损量(TPD)来评估，TPD表示应激性、静息和缺血性的灌注异常。应力、静息和缺血区的视觉和定量大小之间存在高度的线性相关(R=0.94，0.92，0.84)。对于应激(R=0.97vsR=0.91，P=0.03)和静息缺损区(R=0.94vsR=0.82，P=0.03)，两种测试的相关性分别高于目测法(R=0.97vsR=0.91，P=0.03)，而对于缺血区(R=0.84vsR=0.70，P=ns)，两者的相关性在统计学上是相似的。在有连续SPECT MPI的稳定患者中，血流灌注异常程度的量化比视觉更具重复性，这表明它在随机临床试验和监测个别患者的治疗效果方面具有优越性。
Current guidelines of Food and Drug Administration for the evaluation of SPECT myocardial perfusion imaging (MPI) in clinical trials recommend independent visual interpretation by multiple experts. Few studies have addressed whether quantitative SPECT MPI assessment would be more reproducible for this application. We studied 31 patients (age 68 ± 13, 25 male) with abnormal stress MPI who underwent repeat exercise (n = 11) or adenosine (n = 20) MPI within 9-22 months (mean 14.9 ± 3.8 months) and had no interval revascularization or myocardial infarction and no change in symptoms, stress type, rest or stress ECG, or clinical response to stress on the second study. Visual interpretation per FDA Guidance used 17-segment, 5-point scoring by two independent expert readers with overread of discordance by a third expert, and percent myocardium abnormal was derived from normalized summed scores. The quantitative magnitude of perfusion abnormality was assessed by the total perfusion deficit (TPD), expressing stress, rest, and ischemic perfusion abnormality. High linear correlations were observed between visual and quantitative size of stress, rest, and ischemic defects (R = 0.94, 0.92, 0.84). Correlations of two tests were higher by quantitative than by visual methods for stress (R = 0.97 vs R = 0.91, P = 0.03) and rest defects (R = 0.94 vs R = 0.82, P = 0.03), respectively, and statistically similar for ischemic defects (R = 0.84 vs R = 0.70, P = ns). In stable patients having serial SPECT MPI, quantification is more reproducible than visual for magnitude of perfusion abnormality, suggesting its superiority for use in randomized clinical trials and monitoring the effects of therapy in an individual patient.
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