電腦斷層衰減校正鉈201心肌灌注掃描對於疑似冠狀動脈心臟病患者之診斷表現

Abstract

背景與目標：心肌灌注掃描為使用已久且公認可信的冠狀動脈心臟病診斷工具。然而心肌灌注掃描的完整臨床潛力，由於許多因素因而還未發展完全，例如軟組織所造成的衰減問題。在此研究中，我們試圖透過額外的電腦斷層衰減校正，以改善心肌灌注掃描的診斷性能，採用冠狀動脈血管攝影作為參考標準。 方法：本研究包含108位接受電腦斷層衰減校正心肌灌注掃描的病人，且於3個月內接受冠狀動脈血管攝影。影像分析採用標準17分節及5分制評分系統完成。診斷性能以靈敏度，特異性，接收者操作特徵曲線與曲線下面積呈現。亞組分析按性別及超重與正常體重來進行。 結果：電腦斷層衰減校正在診斷患者冠狀動脈心臟病、左前降支及左迴旋支冠狀動脈狹窄，特異度顯著上升(0.62對0.38，p值=0.001；0.56對0.39，P值=0.001；0.76對0.59，P值<0.001)，但在靈敏度則無明顯變化。導致接收者操作特徵曲線與曲線下面積上升(0.79對0.68，P值<0.001；0.75對0.66，P值<0.001；0.73對0.66，P值=0.007)。在診斷右冠狀動脈狹窄方面，電腦斷層衰減校正使得特異度顯著改善，但靈敏度下降。導致接收者操作特徵曲線與曲線下面積無顯著變化(電腦斷層衰減校: 0.71，無校正: 0.66，P值=0.13）。 結論：電腦斷層衰減校正應常規使用到鉈-201心肌灌注掃描，因為衰減校正可增進冠狀動脈心臟病診斷之確定性

Background and Objectives: Myocardial perfusion imaging (MPI) is well established diagnostic tool for coronary artery disease (CAD). However, the full clinical potential of MPI has not been realized due to many factors of artifacts, such as soft tissue attenuation. In this study we tried to improve diagnostic performance of MPI by additional computed tomography attenuation correction, using coronary angiography as the reference standard. Methods: We included a group of 108 patients who underwent computed tomography attenuation corrected (CTAC) MPI and received coronary angiography within 3 months after MPI. Image analysis was done with 17 segments and a standard 5-point scoring system. Diagnostic performance was presented in sensitivity, specificity, receiver operating characteristic curve with area under curve (AUC). Subgroup analyses were performed by gender and overweight versus normal weight. Results: CTAC showed significant improvement of specificity when diagnosing patient level CAD, left anterior descending and left circumflex artery stenosis (0.62 vs 0.38, p=0.001; 0.56 vs 0.39, p=0.001; 0.76 vs 0.59, p<0.001, respectively), but no significant change in sensitivity. Resulting in improvement of AUC (0.79 vs 0.68, p<0.001; 0.75 vs 0.66, p<0.001; 0.73 vs 0.66, p=0.007). In right coronary artery territory, CTAC showed both significant improvement of specificity, and decline of sensitivity. Resulting in no significant change in AUC (CTAC 0.71, Non-attenuation correction 0.66, p=0.13). Conclusion: CTAC should be routinely applied to thallium-201 MPI, because it improved diagnostic certainty in CAD.