Mehmet ERDOGAN, Bayram Ali UYSAL, Mustafa KARABACAK, Mevlut Serdar KUYUMCU, Mustafa AVCI, Samet YAĞCI, Adnan KARAIBRAHIMOGLU, Sevim Süreyya SENGUL

THE ABILITY OF QUANTITATIVE DATA EVALUATED BY 99mTc-MIBI MYOCARDIAL PERFUSION SCINTIGRAPHY TO PREDICT CORONARY ARTERY DISEASE

ObjectiveAlthough the efficacy of the visual interpretation of99mTc-MIBI myocardial perfusion scintigraphy hasbeen repeatedly confirmed in the diagnostic and prognostic evaluation of coronary artery disease (CAD),the efficacy of the automated quantitative evaluationdependent on computer programs is controversial. Inour study, we compared automated quantitative data,such as the sum stress score (SSS) and the sumdifference score (SDS), with coronary angiographyresults. We investigated the ability of SSS and SDSvalues to predict coronary artery disease.Materials and MethodsSSS and SDS are measurements used in the globalscoring of myocardial perfusion. While SSS indicatesthe degree of ischemia, SDS defines the reversibilitydegree of ischemia. In the global scoring of myocardial perfusion, when the SSS was 4 and above, MPSwas evaluated as positive. In the coronary angiography, a stenosis value of >50% was evaluated aspositive. 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 belowand above 10%. We compared the subsequent quantitative data with the results of the three groups ofcoronary angiographies (70%stenosis).ResultsA total of 104 patients who underwent angiographywere included in the study. The accuracy in detectingpositivity between the general quantitative MPS andangiography methods of the patients was calculated as 80.8%. The agreement value was found to besignificant (Kappa=0.602; p

99MTC-MIBI MİYOKARD PERFÜZYON SİNTİGRAFİSİ İLE DEĞERLENDİRİLEN KANTİTATİF VERİLERİN, KORONER ARTER HASTALIĞINI ÖNGÖRME KABİLİYETİ

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. Gereç ve 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 (%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

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1. Goff Jr DC, Lloyd-Jones DM, Bennett G, Coady S, D’Agostino Sr RB, Gibbons R, Greenland P, Lackland DT, Levy D, O’Donnell CJ, Robinson JG, Schwartz JS, Shero ST, Smith Jr SC, Sorlie P, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/Ameri- can Heart Association Task Force on Practice Guidelines. Circulation 2014; 129(25 Suppl. 2):S49–73.

2. Monika Czaja, Zbigniew Wygoda, Agata Duszańska, Dominik Szczerba, Jan Głowacki, Mariusz Gąsior, Jarosław P. Wasilewski. Interpreting myocardial perfusion scintigraphy using single-photon emission computed tomography. Kardiochriugia i Torakochirurgia Polska 2017; 14 (3): 192-199

3. Leslie, Shawn A. Tully, Marina S. Yogendran, Linda M. Ward, Khaled A. Nour, and Colleen J. Metge. Prognostic Value of Automated Quantification of 99m Tc-Sestamibi Myocardial Perfusion Imaging. J Nucl Med. 2005;46:204-211.

4. Yoda S, Nakanishi K, Tano A, Hori Y, Suzuki Y, Matsumoto N, Hirayama A. Validation of automated quantification of nuclear cardiology in Japanese patients using total perfusion deficits: comparison with visual assessment. J Cardiol 2014; 63: 350- 357.

5. Berman DS, Kang X, Gransar H, Gerlach J, Friedman JD, Hayes SW, Thom- son LE, Hachamovitch R, Shaw LJ, Slomka PJ, Yang LD, Germano G. Quantita- tive assessment of myocardial perfusion abnormality on SPECT myocardial perfusion imaging is more reproducible than expert visual analysis. J Nucl Cardiol 2009; 16: 45-53.

6. Hachamovitch R, Rozanski A, Hayes SW, Thomson LE, Germano G, Fried- man JD, Cohen I, Berman DS. Predicting therapeutic benefit from myocardial revascularization procedures: are measurements of both resting left ven- tricular ejection fraction and stress-induced myocardial ischemia necessary? J Nucl Cardiol 2006; 13: 768-778.

7. Weintraub WS, Karlsberg RP, Tcheng JE, Boris JR, Buxton AE, Dove JT, et al. ACCF/AHA 2011 key data elements and definitions of a base cardiovascular vocabulary for electronic health records: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Clinical Data Standards. J Am Coll Cardiol. 2011;58(2):202–222.

8. Patel MR, Bailey SR, Bonow RO, Chambers CE, Chan PS, Dehmer GJ, et al. ACCF/SCAI/AATS/AHA/ASE/ASNC/HFSA/ HRS/SCCM/SCCT/SCMR/STS 2012 Appropriate use criteria for diagnostic catheterization: a report of the American College of Cardiology Foundation. Appropriate use criteria Tak Force, Society for Cardiovascular Angiography and Interventions, American Association for Thoracic Surgery. J Am Coll Cardiol. 2012;59(22):1995–2027.

9. Hendel RC, Budoff MJ, Cardella JF, Chambers CE, Dent JM, Fitzgerald DM, et al. ACC/ACR/ASE/ASNC/HRS/NASCI/ RSNA/SAIP/SCAI/SCCT/SCMR/SIR 2008 key data elements and definitions for cardiac imaging: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards (Writing Committee to Develop Clinical Data Standards for Cardiac Imaging) J Am Coll Cardiol. 2009;53(1):91–124.

10. Fatma Aboul-Enein, Majed O. Aljuaid, Hail T. Alharthi, Abdulkarim M. Almudhhi, Mohammad A. Alzahrani. Hindawi Publishing Corporation Cardiology Research and Practice Volume 2016, Article ID 9847575, 6 pages http://dx.doi. org/10.1155/2016/9847575

11. Shelley S, Indirani M, Sathyamurthy I, Subramanian K, Priti N, Harshad K, et al. Correlation of myocardial perfusion SPECT with invasive and computed tomography coronary angiogram. Indian Heart J. 2012;64(1):43–9. doi: 10.1016/S0019- 4832(12)60010-8.

12. Fard-Esfahani A, Fallahi B, Saghari M, Eftekhari M, Beiki D. Myocar- dial perfusion scan accuracy in detection of coronary artery disease- comparison with exercise stress test [In Persian]. Iran J Nucl Med. 2007;15:16–23.

13. Fiechter M, Ghadri JR, Kuest SM, Pazhenkottil AP, Wolfrum M, Nk- oulou RN, et al. Nuclear myocardial perfusion imaging with a novel cadmium-zinc-telluride detector SPECT/CT device: first vali- dation versus invasive coronary angiography. Eur J Nucl Med Mol Imaging. 2011;38(11):2025–30. doi: 10.1007/s00259- 011-1877-y.

14. Berman DS, Kang X, Van Train KF, et al. Comparative prognostic value of automatic quantitative analysis versus semiquantitative visual analysis of exercise myocardial perfusion single-photon emission computed tomography. J Am Coll Cardiol. 1998;32:1987–1995.