99mTc-MIBI Miyokard Perfüzyon Sintigrafisi ile Değerlendirilen Kantitatif Verilerin, Koroner Arter Hastalığını Öngörme Kabiliyeti

Öz

Amaç: 99mTc-MIBI miyokardiyal perfüzyon görüntülemenin, visual yorumunun etkinliği, koroner arter hastalığının (KAH) tanısal ve prognostik değerlendirmesinde defalarca doğrulanmasına rağmen, bilgisayar programlarına bağımlı otomatik kantitatif değerlendirmenin etkinliği tartışma konusudur. Biz çalışmamızda, sum stress score (SSS) ve sum difference score (SDS) gibi otomatik kantitatif verileri, koroner anjiyografi sonuçları ile karşılaştırdık. SSS ve SDS değerlerinin, koroner arter hastalığını öngörme kabiliyetini araştırdık. Yöntem: SSS ve SDS, myocardial perfüzyonun global skorlamasında kullanılan ölçümlerdir. SSS’u iskeminin derecesini gösterirken, SDS iskeminin geri döndürülebilir olma derecesini tanımlar. Myokardiyal perfüzyonun global skorlamasında, SSS’u 4 ve üzerinde ise MPS pozitif olarak değerlendirildi. Koroner anjiografide ise >%50 üzerinde darlık pozitif olarak değerlendirildi. SSS’nu hafif (4-8), orta (9-12) ve ileri (>13) düzeyde hipoperfüzyon olmak üzere 3 gruba ayırdık. SDS’nu %10 un altı ve üstü olmak üzere 2 gruba ayırdık. Bu kantitatif verileri, 3 grup koroner anjiyografi sonuçlarıyla karşılaştırdık (<%50, %50-70, >%70 darlık). Bulgular: Çalışmaya toplam 104 anjiyo uygulaması yapılan hasta dahil edildi. Hastaların genel kantitatif MPS ve anjiyografi yöntemleri arasındaki pozitiflik tespitindeki doğruluk %80,8 olarak hesaplandı. Uyuşum değeri anlamlı bulundu (Kappa=0,602; p<0,001). SSS grupları ile anjiyografi grupları karşılaştırıldığında, uyuşum değeri orta düzeyde fakat anlamlı bulundu (Kendall’s tau-b=0,373; p=0,014). SDS grupları ile anjiyografi grupları karşılaştırıldığında, uyuşum değeri düşük düzeyde anlamlı bulundu (Kendall’s tau-b=0,234; p=0,014). Sonuç: MPS’de genel kantitatif değerlendirmenin, KAH’nı tahmin etme değeri yüksek olarak bulunmakla birlikte ayrıntılı myokardiyal perfüzyon skorlamanın (SSS, SDS), KAH’lığını tespit oranları yeterli düzeyde değildi. Dolayısıyla sadece myokardiyal perfüzyon skorlamanın, KAH’nı tespit etmede yetersiz kalacağını, kantitatif değerlendirmenin, visual değerlendirmeye tamamlayıcı olarak kullanılması gerektiğini öneriyoruz.

Anahtar Kelimeler

• Miyokard Perfüzyon Sintigrafisi
• SSS
• SRS
• SDS

The Ability of Quantitative Data Evaluated by 99m Tc-MIBI Myocardial Perfusion Scintigraphy to Predict Coronary Artery Disease

Öz

Objective: Although the efficacy of the visual interpretation of 99mTc-MIBI myocardial perfusion imaging has been repeatedly confirmed in the diagnostic and prognostic evaluation of coronary artery disease (CAD), the efficacy of the automated quantitative evaluation dependent on computer programs is controversial. In our study, we compared automated quantitative data, such as the sum stress score (SSS) and the sum difference score (SDS), with coronary angiography results. We investigated the ability of SSS and SDS values to predict coronary artery disease. Method: SSS and SDS are measurements used in the global scoring of myocardial perfusion. While SSS indicates the degree of ischemia, SDS defines the reversibility degree of ischemia. In the global scoring of myocardial perfusion, when the SSS was 4 and above, MPI was evaluated as positive. In the coronary angiography, a stenosis value of >50% was evaluated as positive. We divided the SSS into three groups; mild (4-8), moderate (9-12), and advanced (>13) hypoperfusion. We divided the SDS into two groups as below and above 10%. We compared the subsequent quantitative data with the results of the three groups of coronary angiographies (<50%, 50-70%, and >70% stenosis). Results: A total of 104 patients who underwent angiography were included in the study. The accuracy in detecting positivity between the general quantitative MPI and angiography methods of the patients was calculated as 80.8%. The agreement value was found to be significant (Kappa=0.602; p<0.001). When the SSS groups and angiography groups were compared, the agreement value was found to be moderate but significant (Kendall's tau-b=0.373; p=0.014). Comparing the SDS groups and angiography groups, the agreement value was found to be significant at a low level (Kendall's tau-b=0.234; p = 0.014). Conclusion: Although general quantitative evaluation in MPI had a high predictive value of CAD, the CAD detection rates of detailed myocardial perfusion scoring (SSS, SDS) were not at a sufficient level. Therefore, we suggest that myocardial perfusion scoring alone will be insufficient in detecting CAD, and quantitative evaluation should be used as a complement to visual evaluation.

Anahtar Kelimeler

• Myocardial Perfusion Scintigraphy
• SSS
• SRS
• SDS

Kaynakça

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