| Part?The effect of the cardiac blood flow quantitative performance by complete physical correction of DySPECTAims:The aim of this study was to investigate the difference of cardiac blood flow quantitative results of multi-pinhole CZT SPECT dynamic imaging with systemic complete physical correction,partial physical correction and no physical correction.Methods:N ineteen patients with coronary artery disease confirmed by coronary angiography were included in the study.Average age:64(43 to 82);average BMI:26(21.3 to 32.9).At least one of the three coronary arteries had lesions of more than 50%stenosis confirmed by coronary angiography.The clinical status of all CAD patients were stable when DySPECT acquisition.Each enrolled subject signed an informed consent.DySPECT correction include noise reduction(NR),resolution recovery(RR),corrections for scatter(SC),corrections forattenuation(AC)and partial volume corrections.The evaluation index is the quality index(R2)and blood-pool spillover index(FBV),rest myocardial blood flow(SMBF)and stress myocardial blood flow(SMBF).Results:Visually,the enhancement of physical correction improves image quality by reducing image noise,enhancing image resolution,and increasing image uniformity of myocardium and blood pool regions.In all data sets,the NC group had the lowest R2(0.67)and the highest FBV(0.38)(both P values were statistically significant),compared with the complete physical correction.The improvement in quality and the decrease in spill-over effects were consistent with the increase in correction terms as compared with the complete physical correction.Compared with full physical correction,no physical correction or partial physical correction consistency overestimates RMBF and SMBF with statistically significant.Overestimated MFR without any physical correction with statistically significant.Although MFR was slightly overestimated by some physical corrections,there was no statistical difference.Conclusion:DySPECT imaging without physical correction can affect the results of MBF quantification by reducing the quality of flow uniformity and curve fitting in the kinetic model.Complete physical correction is necessary for the clinical application of SPECT.PART ?Clinical application of dynamic SPECT in predicting coronary artery stenosisAims:The gold standard in this study was the degree of coronary stenosis measured by coronary angiography,The myocardial ischemic range measured by DySPECT and conventional myocardial perfusion imaging was compared with the degree of coronary artery stenosis(assessment criteria:50%).To verify the ability of DySPECT to predict the degree of coronary stenosis better than conventional myocardial perfusion imaging and verify the usefulness of DySPECT in predicting the degree of coronary artery stenosis.Methods:Patients who applied for SPECT myocardial perfusion imaging and underwent coronary angiography in fuwai hospital,Tianjin teda cardiovascular hospital and China-Japan Friendship hospital were successively recruited from April 1,2018 to March 1,2019.Coronary angiography,Myocardial Perfusion Imaging(MPI)and dynamic SPECT Myocardial Blood Flow Quantitation(MBFQ)were performed in all subjects.MPI were processed by QPS software.Summed stress score(SSS),summed rest score(SRS)and summed difference score(SDS)were obtained for the 17 myocardial phase;Transient ventricular dilatation(TID)indices from transient stressing left ventricular volume to resting left ventricular volume ratio.A nuclear medicine cardiac image processing software,MyoFlowQ,which can measure the rest flow(ml/min/g),stress flow(ml/min/g)and myocardial flow reserve(MFR)of each myocardium in the left ventricle.The blood flow station include definitely normal,normal limit,mild abnormal,moderate abnormal,ischemia,steal and infarct.Evaluation criteria for coronary heart disease:MPI:SSS?4 or SDS?2 or TID?1.19.MBFQ:ischemia+steal?3.01%of left ventricle or moderate abnormal+ischemia+steal?20.3%.The rest were assessed as non-coronary heart disease.Results:From April 1,2018 to March 31,2019,a total of 189 patients who applied for SPECT MPI imaging in the nuclear medicine departments of three hospitals were recruited continuously.Nine patients were excluded for lack of coronary angiography,15 for incomplete SPECT imaging,3 for poor SPECT MPI imaging,and 2 for prior valve disease history.Finally 160 cases were enrolled.When the gold standard was CAG stenosis>50%,the sensitivity of MBFQ in diagnosing coronary artery lesions was 0.72,and the accuracy was 0.725.The sensitivity and accuracy of routine myocardial perfusion imaging(MPI)were 0.475 and 0.556,respectively.The difference was statistically significant.(sensitivity P<0.001,accuracy P=0.002).When the gold standard was CAG stenosis>70%,the sensitivity of MBFQ in diagnosing coronary artery lesions was 0.841.Accuracy is 0.75.The sensitivity and accuracy of MPI were 0.537 and 0.631.The difference was statistically significant,(sensitivity P<0.001,accuracy P=0.029).Group by the number of diseased vessels,MBFQ detected 11 cases of vessel zero-vessel lesions,a total of 42 cases,with a positive rate of 26.19%.The positive rate of MPI on zero-vessel group was 21.43%(p=0.798).The positive rate of MBFQ on one-vessel group was 60.420%,MPI was 50%(p=0.412).The positive rate of MBFQ on two-vessels group was 70.27%,MPI was 40.54%(p=0.034).The positive rate of MBFQ on three-vessels group was 90.91%,MPI was 51.52%(p=0.001).Grouping by the degree of stenosis of the diseased vessels,MBFQ detected 11 cases of CAG<50%stenosis,a total of 42 cases,with a positive rate of 26.19%.The positive rate of MPI on CAG<50%stenosis group was 21.43%(p=0.798).50-70%group the positive rate of MBFQ was 44.44%,MPI was 33.33%(p=0.469).The positive rate of MBFQ on CAG?70%stenosis group was 84.15%,MPI was 53.66%(p<0.001).Conclusions:The ability of DySPECT to detect myocardial ischemia,especially the myocardial ischemia caused by multi-branch lesions,was better than that of conventional myocardial perfusion imaging.DySPECT is safe and effective in predicting the degree of coronary artery stenosis. |
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