核素心肌灌注显像定量分析技术诊断本地人群冠心病的价值

目的 研究基于西方人群的核素心肌灌注显像（MPI）定量分析技术应用于本地人群时对冠心病的诊断准确性.方法 （1）选择72例3个月内同期行冠状动脉造影（CAG）和MPI的患者为试验组 （2）在Cedars quantitative perfusion SPECT（QPS）软件平台上,建立QPS简单法数据库,从140例冠心病可能性＜5%、已行两日法99Tcm-甲氧基异丁基异腈（MIBI）MPI的患者中选择80例建立本地人正常MPI数据库 （3）采用2种西方人正常MPI数据库（分别为数据库1和数据库2）和本地人正常MPI数据库,对试验组患者的MPI图像进行定量分析,并与目测法结果进行比较.均数间比较采用t检验,受试者工作特征（ROC）曲线下面积（AUC）比较采用z检验.结果 数据库2和本地人正常MPI数据库对试验组患者的MPI进行定量分析显示,缺血总范围（EXT）分别为（10.73±14.54）%和（14.22±16.51）%（t=7.87,P＜0.001）,缺血总严重程度（SEV）分别为1.07±0.93和1.34±1.20（t=7.45,P＜0.001）.以EXT为定量诊断参数时,本地人正常MPI数据库所得AUG为0.85±0.05,与数据库1（0.72±0.06,z=2.50,P＜0.01）和数据库2（0.77±0.06,z=2.47,P＜0.01）的AUC比较,差异均有统计学意义,但与目测半定量法负荷总积分（V-SSS）作为诊断参数的AUC（0.83±0.05）相比差异无统计学意义（z=0.05,P＞0.05）.结论 以西方人正常MPI数据库为基础的定量分析技术应用于本地人群时会低估患者的心肌缺血面积和严重程度,会降低对冠心病诊断的准确性.

The accuracy of myocardial perfusion imaging using quantitative analysis for patients with coronary artery disease: a Chinese hospital experience

Objective To evaluate the accuracy of automated quantification of myocardial perfusion imaging (MPI) using a method based on a Western normal database for the detection of coronary artery disease (CAD) in a group of Chinese patients. Methods Seventy-two Chinese patients who underwent coronary angiography (CAG) and MPI within 3 months were recruited into this study. Eighty selected from 140 Chinese patients with low probability of CAD ( ＜ 5% ) were enrolled into local normal database of 99Tcm-methoxyisobutylisonitrile (MIBI) MPI using Cedars quantitative perfusion SPECT (QPS) database. Two Western MPI normal databases (CSMC MibiMbiAuto and Mibimibi) were used for processing the Chinese CAD patients recruited in this study, and the results were compared with those using local normal database and visual interpretation. T-test and z-test were used for statistical analysis. Results The extent (EXT)measurement obtained from Mibimibi and local database was ( 10.73 ± 14.54)% and ( 14.22 ± 16.51 )%,respectively ( t = 7.87, P ＜ 0.001 ); the severity (SEV) was 1.07 ± 0.93 and 1.34 ± 1.20, respectively ( t =7.45, P＜0.001). The area under curve(AUC) by using EXT measurement for local database (0.85 ±0.05) was larger than that for CSMC MibiMbiAuto ( AUC = 0.72 ± 0.06, z = 2.50, P ＜ 0.01 ) and Mibimibi ( AUC = 0.77 ± 0.06, z = 2.47, P = 0.014). The AUC of local database showed no significant difference from that of visual interpretation (AUC=0.83 ±0.05, z=0.05, P＞0.05). Conclusion Quantification of MPI of our Chinese patients using Western normal database would decrease the accuracy for the detection of CAD.