Comparative prognostic value of automatic quantitative analysis versus semiquantitative visual analysis of exercise myocardial perfusion single-photon emission computed tomography
Comparative prognostic value of automatic quantitative analysis versus semiquantitative visual analysis of exercise myocardial perfusion single-photon emission computed tomography
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DOI：
10.1016/s0735-1097(98)00501-4
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发表时间：
1998-12-01
影响因子：
24
通讯作者：
Hachamovitch, R
中科院分区：
文献类型：
--
作者：
Berman, DS;Kang, XP;Hachamovitch, R
目标.本研究的目的是确定运动双同位素心肌灌注单光子发射计算机断层扫描（SPECT）自动定量分析的预后价值，并比较定量分析与半定量可视化SPECT分析的预后价值。运动心肌灌注缺损的程度、严重程度和可逆性与预后相关，然而，大多数关于SPECT对慢性冠状动脉疾病（CAD）预后价值的研究都是基于专家的直观分析。我们研究了1，043例已知或疑似CAD的连续患者，这些患者接受了静息Tl-201/运动Tc-99 m sestamibi双同位素心肌灌注SPECT，并随访至少1年（平均20.0 ± 3.7个月）。在筛选了59例早期冠状动脉旁路移植术或经皮冠状动脉腔内成形术患者后，通过定量SPECT缺陷分析，10%），严重度（>150）和可逆性（>5%），以及那些扫描异常的患者（>2个异常节段，总应力评分>4和总差异评分>2）通过半定量视觉SPECT分析，与扫描正常的患者相比，硬事件发生率显著更高（p < 0.001）。通过视觉和定量分析，在20个月的随访期内，正常扫描的硬事件发生率约为1%，异常扫描的硬事件发生率约为5%（p > 0.05）。考克斯比例风险回归模型显示，在考虑临床和运动变量后，随着定量缺陷程度和视觉总应力评分变量的增加，卡方增加相似（两者的卡方改善= 11，p < 0.0007）。定量分析与目测分析的受试者工作特征曲线下面积差异无显著性（p > 0.70）。线性回归分析也表明，定量评估与视觉半定量评估相关良好。这项研究的结果表明，运动负荷心肌灌注SPECT的自动定量分析是类似于半定量专家视觉分析的预后分层，这些结果可能是特别的临床意义，在实验室经验不足的视觉口译。（J Am科尔心脏病学1998;32：1987-95）（C）1998年美国心脏病学会。
Objectives. The purpose of this study was to determine the prognostic value of automatic quantitative analysis in exercise dual-isotope myocardial perfusion single-photon emission computed tomography (SPECT) and to compare the prognostic value of quantitative analysis to semiquantitative visual SPECT analysis.Background. Extent, severity and reversibility of exercise myocardial perfusion defects have been shown to correlate with prognosis, However, most studies examining the prognostic value of SPECT in chronic coronary artery disease (CAD) have been based on visual analysis by experts.Methods. We studied 1,043 consecutive patients with known or suspected CAD who underwent rest Tl-201/exercise Tc-99m sestamibi dual-isotope myocardial perfusion SPECT and were followed up for at least 1 year (mean 20.0 +/- 3.7 months). After censoring 59 patients with early coronary artery bypass grafting or percutaneous transluminal coronary angioplasty, 10%), severity (>150) and reversibility (>5%) by quantitative SPECT defect analysis, as well as those with an abnormal scan (>2 abnormal segments, summed stress score >4 and summed difference score >2) by semiquantitative visual SPECT analysis, had a significantly higher hard event rate compared to patients with a normal scan (p < 0.001). With both visual and quantitative analyses, hard event rates of approximately 1% with normal scans and 5% with abnormal scans (p > 0.05) were observed over the 20-month follow up period. A Cox proportional hazards regression model showed that chi-square increased similarly with the addition of quantitative defect extent and visual summed stress score variables after considering both clinical and exercise variables (improvement chi-square = 11 for both, p < 0.0007). There were no significant differences in the areas under receiver operating characteristic curves between quantitative and visual analysis (p > 0.70). Linear regression analysis also indicated that quantitative assessments correlated well with visual semiquantitative assessments.Conclusions. The findings of this study indicate that automatic quantitative analysis of exercise stress myocardial perfusion SPECT is similar to semiquantitative expert visual analysis for prognostic stratification, These findings may be of particular clinical importance in laboratories with less experienced visual interpreters. (J Am Coll Cardiol 1998;32:1987-95) (C) 1998 by the American College of Cardiology.