Diagnostic value of early post exercise ~(99)Tc~m-MIBI ECG gated myocardial perfusion imaging in severe coronary artery disease
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Objective To study and compare the diagnostic value in severe coronary artery disease (CAD) of 99 Tc m methoxyisobutylisonitrile (MIBI) electrocardiogram (ECG) gated early post exercise myocardial perfusion imaging (G MPI) with that of non ECG gated myocardial perfusion imaging (NG MPI). Methods Two hundred and fifteen suspected CAD patients had undergone G MPI and coronary artery angiography (CAG) within one month were enrolled and distributed into three vessel and non three vessel CAD groups according to CAG results (≥70%); the diagnostic values in severe CAD of G MPI and NG MPI were gained and compared to determine which one of the two protocols would be superior in identification of severe three vessel CAD. Results When the ≥70% diameter stenosis CAG was the diagnostic standard of severe CAD, the sensitivity of G MPI and NG MPI in the diagnosis of severe CAD were 95.3% (143/150) and 90.7% (136/150, χ 2=2.509, P =0 113), but when the comparison specifically pinpointed to severe three vessel CAD, there was significant difference between G MPI [100%(51/51)] and NG MPI [92.2% (47/51), χ 2=4.163, P =0.041]. Diagnostic specificity of G MPI was 80.0% and that of NG MPI was 72.3% ( χ 2=1.059, P =0.303). Conclusions The incremental diagnostic sensitivity of G MPI adding to the NG MPI in the diagnosis of severe CAD was mainly from the three vessel subgroup patients.Exercise stress G MPI has better diagnostic value in severe three vessel CAD patients than NG MPI.Cite
Objective To explore the value of adenosine(ADE) stress gated myocardial perfusion imaging(G-MPI) and dual-source CT coronary angiography(DSCTCA) in diagnosis of coronary artery disease(CAD).Methods Fifty-three patients with low,medium and high probability of CAD underwent resting(REST),ADE stress G-MPI and DSCTCA,then they underwent CAG within 4 weeks.MPI results were analyzed using the American Heart Association 17 segment 5-point scale(0—4 points) visual semi-quantitative method,and the resting and stress rating of the difference 1 were identified as reversible defect.Coronary stenosis were determined using international common law of DSCTCA visual diameter and were divided into normal and stenosis 50% or ≥50%.Taking CAG results as gold standards and stenosis ≥50% defined as CAD,diagnostic value of MPI and DSCTCA was compared.Results According to CAG results,the sensitivity,specificity and accuracy of G-MPI and DSCTCA in diagnosis of CAD was 94.44%(34/36),52.94%(9/17),81.13%(43/53) and 88.89%(32/36),88.24%(15/17),88.68%(47/53),respectively(χ2=9.28,P=0.005).Conclusion G-MPI and DSCTCA both have high value in diagnosis of CAD,combination of these two methods can improve the diagnostic utility of CAD through obtaining both functional and anatomical information.
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Objective:To study and compare the diagnostic value of ECG-gated and non ECG-gated early post-exercise stress ~ 99m Tc-MIBI myocardial perfusion imaging (MPI) in coronary heart disease(CHD).Method:Two hundred and fifteen known or suspected CHD patients who had undergone coronary angiography and ECG-gated MPI within one month in our hospital were enrolled and values of diagnostic sensitivity, specificity were gained and compared among ETT, non ECG-gated MPI and ECG-gated MPI.Result:When angiographic diameter stenosis ≥50% is the diagnostic standard of CHD, the sensitivity of ETT, non ECG-gated MPI and G-MPI are 58.0%(94/162),88.3%(143/162),90.7%(147/162) ,respectively;the specificity are 67.9%(36/53),79.2%(42/53),88.7%(47/53) , respectively. ETT, non ECG-gated MPI and ECG-gated MPI have incremental diagnostic value in order with the latter two significantly better than ETT (both P0.01). The specificity of non ECG-gated MPI was better than that of ETT (P0.05), and less than ECG-gated MPI (P0.05), while the specificity of ECG-gated MPI is superior to ETT significantly (P0.01).Conclusion:In CHD diagnoses,ECG-gated MPI is significantly better than ETT,and possibly better than non ECG-gated MPI.
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Objective To investigate myocardial perfusion imaging(MPI) combined with coronary CT angiography(CTA) in diagnosis of culprit coronary artery.Methods From 2012 Februarv-2013 December,hospitalized patients with coronary heart disease(33 cases) were enrolled,male of 25 cases,female ol 8 cases,age from 35 to 75 years old(55.2 ±20.2),they were underwent N-NH,PET adenosine/ resting MPI and coronary artery CTA examination,within 1 months of coronary arteriography(CAG),respectively.The MPI,CTA and CAG were analyzed;using CAG as golden standard,the diagnostic value of coronary CTA,MPI and MPI combined coronary artery CTA were analyzed.Results(1) The sensitivity of CTA in diagnosis of coronary heart disease was 90.0%(36/40),the specificity was 95.0%(302/318),the predictive value was 69.2%(36/52),the predictive value was 98.7%(302/306).(2) The sensitivity of MPI in diagnosis of coronary heart disease was 90.9%(20/22),the specificity was 90.9%(10/11),the predictive value was95.2%(20/21),the predictive value was 83.3%(10/12).(3) The sensitivity of MPI combined with CTA in diagnosis ol coronary heart disease was 95.5%(20/21),the specificity was 100%(11/11),the predictive value was100%(21/21),the predictive value was 91.7%(11/12).Conclusion MPI combined with coronary CTA can decrease the false positive and false negative results caused by MPI or CTA alone,provides higher accuracy for the diagnosis and treatment of coronary heart disease,especially to improve the detection rate of culprit vessel.
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Coronary arteries
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Objective
To evaluate the diagnostic value of one-stop cardiac CT (stress dynamic CT-MPI combining with CTA) in CAD.
Methods
Thirty patients underwent CCTA combined with stress dynamic CT-MPI and stress SPECT-MPI including 16 patients underwent ICA were retrospectively enrolled. All procedures were performed within 2 weeks without related treatment. CT-MPI and SPECT-MPI were evaluated visually and MBF was quantified according to dynamic CT-MPI which was compared through paired t test. The diagnostic value of CT-MPI for myocardial ischemia was evaluated with SPECT-MPI as the reference standard. The consistency between the two techniques was determined by Kappa test. With SPECT combined with ICA as the reference standard, we evaluated the value of CT-MPI and its combination with CCTA in the diagnosis of CAD with hemodynamic stenosis.
Results
On stress CT-MPI, 19 of 30 patients and 52 segments were evaluated with myocardial perfusion defects. There was a significant difference in MBF values between normal[(117.61±29.82)ml·100 ml-1·min-1] and hypoperfused [(80.60±22.15)ml·100 ml-1·min-1] segments (t=15.764,P<0.001). With SPECT as reference standard, the sensitivity, specificity were 94.12% (32/34), 95.80% (456/476) on the vessel basis. The Kappa value of the two examinations was 0.772(P<0.001). As for the 16 patients who also underwent ICA, 15 patients with 22 vessel-areas had hemodynamic stenosis on CT-MPI. Compared with SPECT combined with ICA, the sensitivity, specificity for detecting hemodynamic stenosis were 92.31% (12/13), 71.43% (25/35) for CT-MPI; 100% (13/13), 51.43% (18/35) for CTA and 92.31% (12/13), 82.86% (29/35) for CT-MPI combined with CTA, respectively. Moderate correlation was observed between the combination of CT-MPI and CCTA and reference standard (r=0.690, P<0.001).
Conclusion
Stress dynamic CT-MPI can detect myocardial perfusion defects and hemodynamic changes and improves the diagnostic ability of functional stenosis of CAD combined with CTA, which can finally achieve the one-stop mode of cardiac CT in CAD.
Key words:
Myocardial ischemia; Tomography, X-ray computed; Myocardial perfusion imaging; Coronary stenosis
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Objective To evaluate the diagnostic accuracy of a combined non-invasive assessment of coronary artery disease with coronary computed tomography angiography(CCTA) and myocardial perfusion imaging(MPI) for the detection of flow-limiting coronary stenoses and its potential as a gatekeeper for invasive examination and treatment.Methods A total of 78 patients with known or suspected coronary artery disease(CAD) were examined by adenosine stress/rest MPI and coronary angiography(CAG) within one month,at the same time these patients underwent CCTA with the same SPECT/CT facility.MPI was evaluated by semi-quantitative visual interpretation using a 15-segment model.According to CAG and CCTA standard,a significant stenosis was defined as a diameter reduction of ≥50%.Detection of flow-limiting stenoses(justifying revascularization) by the combination of CCTA and MPI(MPI/CCTA) was compared with the combination of CAG plus MPI(MPI/CAG),which served as standard of reference.Results In 78 patients,MPI image revealed 66 reversible,6 fixed and 6 normal.The distribution of the perfusion defects among the different coronary artery territories was as follows: reversible perfusion defects: left anterior descending artery(LAD)(n=55),left circumflex artery(LCX)(n=14),right coronary artery(RCA)(n=11);fixed perfusion defects: LAD(n=4);RCA(n=3).CCTA image analysis revealed a stenosis in 74/234 coronary arteries of 56/78 patients.MPI/CCTA image analysis revealed a stenosis in 56/78 patients.The diagnostic sensitivity,specificity,accuracy,positive and negative predictive values by MPI/CCTA vs MPI/CAG for the detection of flow-limiting coronary stenosis on patient-based and vessel-based analysis were 94.33%,72.00%,87.18%,87.71%,85.71% and 88.71%,92.44%,91.45%,80.89%,95.78%.All of revascularization procedures(46,100%) were associated with ischemia on MPI,but more than a third(25/67,37%)of revascularized vessels were not associated with ischemia on MPI.Conclusion The combined non-invasive approach MPI/CCTA has an excellent acuracy to detect flow-limiting coronary stenoses compared with MPI/CAG.Its advantage lies in the non-invasive evaluation of coronary anatomy and function,and its use as a gatekeeper appears to make a substantial part of revascularization procedures redundant.
Fractional Flow Reserve
Coronary arteries
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Circumflex
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Objective To compare the diagnostic values of rest 99Tcm-MIBI MPI and two-dimensional echocardiography (2-DE) for the detection of coronary artery damage at sub-acute phase of Kawasaki disease (KD).Methods Twenty-four children (14 males and 10 females,mean age:(2.50±2.19)years) with KD at sub-acute phase were studied between August 1999 and March 2012.All patients underwent rest 99Tcm-MIBI MPI and 2-DE.x2 and Wilcoxon rank sum tests with SPSS 13.0 were used for data analysis.Results The positive rate of MPI was 66.67％ (16/24),significantly higher than that of 2-DE (37.50％,9/24; x2 =4.00,P＜0.05).There was no significant difference between the duration for definite diagnosis by MPI and 2-DE ((13.79±2.86) vs (15.89±5.60) d; Z=-0.746,P＞0.05).Eight of 24 patients (33.33％) had positive results for both MPI and 2-DE,and 7 patients (29.17％) had negative findings for both methods.Eight patients (8/24,33.33％) were positive on MPI but negative on 2-DE,and 1 patient (1/24,4.17％) was positive on 2-DE but negative on MPI.The areas of myocardial ischemia detected by MPI in 4 patients were consistent with the findings by 2-DE.Conclusions Rest 99Tcm-MIBI MPI is a valuable noninvasive method to evaluate the coronary circulation and myocardial ischemia in KD patients at sub-acute phase.In combination with MPI,2-DE might provide more comprehensive information for the evaluation of KD.
Key words:
Mucocutaneous lymph node syndrome; Coronary disease; Tomography,emission-computed, single-photon; Echocardiography; MIBI
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Myocardial perfusion imaging (MPI) is an accurate noninvasive test for patients with suspected obstructive coronary artery disease (CAD) and coronary artery calcium (CAC) score is known to be a powerful predictor of cardiovascular events. Collection of CAC scores simultaneously with MPI is unexplored.We aimed to investigate whether automatically derived CAC scores during myocardial perfusion imaging would further improve the diagnostic accuracy of MPI to detect obstructive CAD.We analyzed 150 consecutive patients without a history of coronary revascularization with suspected obstructive CAD who were referred for 82Rb PET/CT and available coronary angiographic data. Myocardial perfusion was evaluated both semi quantitatively as well as quantitatively according to the European guidelines. CAC scores were automatically derived from the low-dose attenuation correction CT scans using previously developed software based on deep learning. Obstructive CAD was defined as stenosis >70% (or >50% in the left main coronary artery) and/or fractional flow reserve (FFR) ≤0.80.In total 58% of patients had obstructive CAD of which seventy-four percent were male. Addition of CAC scores to MPI and clinical predictors significantly improved the diagnostic accuracy of MPI to detect obstructive CAD. The area under the curve (AUC) increased from 0.87 to 0.91 (p: 0.025). Sensitivity and specificity analysis showed an incremental decrease in false negative tests with our MPI + CAC approach (n = 14 to n = 4), as a consequence an increase in false positive tests was seen (n = 11 to n = 28).CAC scores collected simultaneously with MPI improve the detection of obstructive coronary artery disease in patients without a history of coronary revascularization.
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Objective To compare the diagnostic values of treadmill exercise testing(TET), exercise stress SPECT myocardial perfusion imaging(MPI) and dipyridamole stress SPECT MPI in coronary artery disease(CAD).Methods Eighty three suspected CAD patients who had undergone coronary angiography (CAG) were divided into two groups according to the CAG results, the group of CAD(n=37) and the group of Non-CAD(n=46).All patients underwent TET, fifty six patients exercise stress SPECT MPI,and twenty seven patients dipyridamole stress SPECT MPI. Then the sensitivity,specificity, accuracy, positive/negative predictive value of TET, exercise stress SPECT MPI and dipyridamole stress SPECT MPI in diagnosing CAD were compared.Results The sensitivity values of TET, exercise and dipyridamole stress SPECT MPI are 51.4 %,95.5 %,93.3 % respectively;those of specificity are 76.1 %、88.2 %、91.7 % respectively;those of accuracy are 65.1 %、91.1 %、92.6 % respectively;The positive predictive values are 63.3 %、84.0 %、93.3 % respectively and the negative predictive values are 66.0 %、96.8 %、71.7 % respectively.Conclusions The value of exercise stress SPECT MPI is similar to that of dipyridamole stress SPECT MPI in diagnosing CAD, both of which are better than TET.
Dipyridamole
Stress testing (software)
Spect imaging
Treadmill
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Objective:To compare the effect of single myocardial perfusion imaging(MPI) and MPI combined with coronary CT angiography(CCTA) on coronary artery lesion diagnosis in patients of type 2 diabetes mellitus(DM) with coronary artery lesions. Methods:A total of 85 diabetic patients with coronary artery disease(CAD) or suspected CAD were examined by adenosine stress/rest MPI and coronary angiography(CAG) within one month,38 of them underwent CCTA with the same SPECT/CT facility.MPI was evaluated by semi quantitative visual interpretation using a 17-segment model.According to CAG and CCTA stan-dard,the coronary condition was defined as normal,mild,intermediate and severe lesions.CAG and CAG/ MPI combination were used to evaluate the effect of coronary lesion diagnosis for MPI and MPI/CCTA fusion imaging.Results:In 85 patients,MPI presented normal/abnormal was 22/63.MPI diagnostic sensitivity,specificity,accuracy,positive and negative prediction rate for coronary lesions were 80.19%,88.59%,85.10%,83.33% and 86.27% respectively;it showed 20(24%) mild lesion cases,12(14%) intermediate lesion cases and 31(36%) severe lesion cases.For 38 patients who underwent CCTA,the diagnostic sensitivity,specificity,accuracy,positive and negative prediction rate by MPI vs.MPI/CCTA were 74.55% vs.96.97%,81.36% vs.91.67%,78.07% vs.94.74%,78.85% vs.94.12% and 77.42% vs.95.65% respectively.MPI/CCTA fusion imaging presented normal 40.35%(46 segment /114 branch),intermediate or more stenosis 59.65%(68 segment /114 branch).Conclusion:MPI/CCTA fusion imaging has been superior to MPI alone for early CAD diagnosis in DM patients with coronary artery lesions.
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Objective
To investigate the incremental value of coronary flow reserve (CFR) assessed by cadmium zinc telluride(CZT)-SPECT as an adjunct to myocardial perfusion imaging (MPI) in the diagnosis of coronary artery disease (CAD).
Methods
Data of 132 patients (89 males, 43 females; 40-81 years) with or suspected with CAD who successfully underwent rest and stress MPI and CFR from November 2017 to October 2018 in Zhongshan Hospital Affiliated to Fudan University were retrospectively analyzed. Based on coronary angiography (CAG) as the gold standard , the value of MPI and MPI+ CFR in the diagnosis of CAD was evaluated and compared. χ2 test or Fisher exact probability test was used for data analysis.
Results
Of 132 patients, 61 (46.2%) were CAD with stenosis of at least 75% in one vessel (47.5%, 29/61), two vessels (34.4%, 21/61), or three vessels (18.0%, 11/61). A total of 104 (26.3%) vessels with stenosis of at least 75%, 25 (6.3%) vessels with stenosis of 65%-74%, and 30 (7.6%) vessels with stenosis of 50%-64% were found in 396 vessels. For detecting coronary stenosis of at least 75%, the sensitivity and accuracy of MPI on per-patient analysis were 86.89%(53/61) and 68.94%(91/132), which increased to 96.72%(59/61; χ2=3.921, P<0.05) and 87.88%(116/132; χ2=13.984, P<0.01) by MPI+ CFR. On per-vessel analysis, the sensitivity and accuracy of MPI were 72.12%(75/104) and 77.53%(307/396) and increased to 96.15%(100/104; χ2=22.511, P<0.01) and 85.10%(337/396; χ2=7.479, P<0.05) by MPI+ CFR. The sensitivity of MPI for predicting one, two, and three vessels disease were 72.41%(21/29), 42.86%(9/21), and 5/11 and were improved to 93.10%(27/29; χ2=4.350, P=0.037), 90.48%(19/21; χ2=10.714, P=0.001), and 11/11 (P=0.012) by MPI+ CFR. For coronary with stenosis of 65%-74%, the sensitivity of MPI was 24.00%(6/25) and was improved to 64.00%(16/25; χ2=8.117, P=0.004) by MPI+ CFR. For coronary with stenosis of 50%-64%, the sensitivity of MPI was 40.00%(12/30) and was improved to 76.67%(23/30; χ2=8.297, P=0.004) by MPI+ CFR.
Conclusion
As an adjunct to MPI, CFR can significantly improve the sensitivity and accuracy in the diagnosis of CAD, particularly for patients with mild stenosis and multivessel CAD.
Key words:
Coronary artery disease; Fractional flow reserve, myocardial; Myocardial perfusion imaging; Tomography, emission-computed, single-photon; Tellurium; Zinc; Cadmium
Coronary flow reserve
Fractional Flow Reserve
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