Diagnostic Performance of Noninvasive Myocardial Perfusion Imaging Using Single-Photon Emission Computed Tomography, Cardiac Magnetic Resonance, and Positron Emission Tomography Imaging for the Detection of Obstructive Coronary Artery Disease A Meta-Analysis
Diagnostic Performance of Noninvasive Myocardial Perfusion Imaging Using Single-Photon Emission Computed Tomography, Cardiac Magnetic Resonance, and Positron Emission Tomography Imaging for the Detection of Obstructive Coronary Artery Disease A Meta-Analysis
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DOI：
10.1016/j.jacc.2011.12.040
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发表时间：
2012-05-08
影响因子：
24
通讯作者：
Schalla, Simon
中科院分区：
文献类型：
--
作者：
Jaarsma, Caroline;Leiner, Tim;Schalla, Simon
目的本研究旨在确定3种最常用的无创性心肌灌注成像方式，单光子发射计算机断层扫描（SPECT），心脏磁共振（CMR）和正电子发射断层扫描（PET）灌注成像诊断阻塞性冠状动脉疾病（CAD）的准确性。此外，测试和研究特点的影响进行了探讨。背景阻塞性CAD的准确检测是重要的有效治疗。非侵入性心肌灌注成像越来越多地被应用于衡量的严重程度CAD。方法1990年和2010年之间发表的研究PubMed搜索和引文跟踪确定进行了检查。结果在3，635篇引文中，166篇（n = 17，901）符合纳入标准：SPECT 114篇，CMR 37篇，PET 15篇。没有足够的关于其他灌注技术（如灌注超声心动图和计算机断层扫描）的出版物将这些模式纳入研究。每种成像方式的基于患者的分析显示，合并敏感性为88%（95%置信区间[CI]：88%至89%），89%（95%CI：88%至91%）和84%（95% CI：81%-87%）;合并特异性为61%（95% CI：59%至62%）、76%（95% CI：73%至78%）和81%（95% CI：74%至87%）。这导致合并诊断比值比（DOR）为15.31（95% CI：12.66至18.52; I-2 63.6%）、26.42（95% CI：17.69至39.47; I-2 58.3%）和36.47（95% CI：21.48至61.92; I-2 0%）。大多数评估的测试和研究的特点并没有影响排名的诊断performance.Conclusions SPECT，CMR，PET都产生了很高的灵敏度，而广泛的特异性进行了观察。SPECT是广泛可用且最广泛验证的; PET实现了最高的诊断性能; CMR可提供无电离辐射的替代方案，并具有与PET相似的诊断准确性。我们建议转诊医生在当地专业知识和基础设施的背景下考虑这些发现。（J Am科尔心脏病学杂志2012;59：1719-28）（C）美国心脏病学会基金会2012年
Objectives This study aimed to determine the diagnostic accuracy of the 3 most commonly used noninvasive myocardial perfusion imaging modalities, single-photon emission computed tomography (SPECT), cardiac magnetic resonance (CMR), and positron emission tomography (PET) perfusion imaging for the diagnosis of obstructive coronary artery disease (CAD). Additionally, the effect of test and study characteristics was explored.Background Accurate detection of obstructive CAD is important for effective therapy. Noninvasive myocardial perfusion imaging is increasingly being applied to gauge the severity of CAD.Methods Studies published between 1990 and 2010 identified by PubMed search and citation tracking were examined. A study was included if a perfusion imaging modality was used as a diagnostic test for the detection of obstructive CAD and coronary angiography as the reference standard (>= 50% diameter stenosis).Results Of the 3,635 citations, 166 articles (n = 17,901) met the inclusion criteria: 114 SPECT, 37 CMR, and 15 PET articles. There were not enough publications on other perfusion techniques such as perfusion echocardiography and computed tomography to include these modalities into the study. The patient-based analysis per imaging modality demonstrated a pooled sensitivity of 88% (95% confidence interval [CI]: 88% to 89%), 89% (95% CI: 88% to 91%), and 84% (95% CI: 81% to 87%) for SPECT, CMR, and PET, respectively; with a pooled specificity of 61% (95% CI: 59% to 62%), 76% (95% CI: 73% to 78%), and 81% (95% CI: 74% to 87%). This resulted in a pooled diagnostic odds ratio (DOR) of 15.31 (95% CI: 12.66 to 18.52; I-2 63.6%), 26.42 (95% CI: 17.69 to 39.47; I-2 58.3%), and 36.47 (95% CI: 21.48 to 61.92; I-2 0%). Most of the evaluated test and study characteristics did not affect the ranking of diagnostic performances.Conclusions SPECT, CMR, and PET all yielded a high sensitivity, while a broad range of specificity was observed. SPECT is widely available and most extensively validated; PET achieved the highest diagnostic performance; CMR may provide an alternative without ionizing radiation and a similar diagnostic accuracy as PET. We suggest that referring physicians consider these findings in the context of local expertise and infrastructure. (J Am Coll Cardiol 2012;59:1719-28) (C) 2012 by the American College of Cardiology Foundation