非一致性衰變校正鉈-201心肌灌注掃描對國人冠心病病灶偵測之研究-與心導管結果相比較

Background: Non-uniformed attenuation correction has been applied in myocardial perfusion single photon emission computed tomography(SPECT)in recent 10 years. However, there are only three hospitals in Taiwan having such equipments. To the best of our knowledge, this is the first paper discussing the diagnostic accuracy of 201TImyocardial SPECT with(AC)and without(NC)non-uniformed attenuation correction in Taiwanese in compared with PTCA study. Materials and Methods: Totally 142 patients with clinically suspicious coronary artery disease(94 male,48 female; mean age 66±11 years old)were included. All had coronary catheterization and 201TI myocardial SPECT(persantin or treadmill exercise)with consent of patients. The 201TI SPECT data were acquired using ADAC Vertex plus and ADAC VANTAGE for transmission and emission scans. Results: The gold standard of this study was stenosis ≥70% of the coronary artery by coronary catheterization. As compared with coronary catheterization, the sensitivity and of AC in anterior(A),inferior(I)and lateral(L)walls was81%,74%,60% and the specificity was 64%,55%,91%,respectively.The accuracy was 70%,61%,and 82%.Thesensitivity of NC in A,I,L walls was 87%,88%,51% and the specificity is 72%,68% and 90%,respectively.Theaccuracy was 79%,74%,and 80%.NC seemed to be better correlated with coronary catheterization in A and l walls but worse in L as compared with AC. However, there was no statistically significant difference between AC and NC in lesion detection(P＞0.05).The reports of nuclear scans were combined reading of AC and NC results, the sensitivity, specificity and accuracy in 82%,59%,67% on anterior wall,84%,54%,62% on inferior wall and 59%,90%,82% on lateral wall, respectively. Conclusion: In comparison with NC,AC provides no significant advantages for lesion detection. AC plus NC yielded sensitivity, specificity and accuracy between AC and NC did. The main problem may be due to low total counts for201TI SPECT examination. To solve this problem, we suggest that using higher dose and longer acquisition time. Besides, we recommend reading AC and NC simultaneously at the time being, if possible. Conclusion to the advantage of AC was not made in this study.