Miyokart perfüzyon sintigrafisinde olgu Seçimi kriterleri: Bölge genelinden sevk edilen ve tek merkezde raporlanan 990 olgunun retrospektif analizi

Amaç: Miyokart perfüzyon sintigrafisi (MPS), koroner arter hastalığı (KAH) tanısında ve prognoz belirlemede modern tıbbın rutin tanı algoritmaları içerisinde yerini almış bir görüntüleme yöntemi olmakla birlikte yurt genelindeki kullanım şekli yeterince araştırılmamıştır. Bu çalışmada, bölgemizde uygulanan MPS endikasyon kriterlerinin retrospektif olarak değerlendirilmesi planlanmıştır. Gereç ve Yöntemler: Toplam 1046 olgu içerisinde nükleer tıp uzmanınca yorumlanmış olan 990 (408 K, 54 ± 8 yıl; 582 E, 45 ± 10 yıl) MPS çalışması (%95) değerlendirmeye alınmış; müphem raporlanmış olan 56 olgu (%5) analize katılmamıştır. Göğüs ağrısı şikayeti, treadmill testi ve bilinen KAH'da koroner anjiyografi (KA)/öykü verilerine göre 10 grup oluşturulmuş ve hastalar KAH beklentisine (KAH-B) göre düşük (grup 1-2), orta (grup 3), yüksek (grup 4) ve bilinen KAH (grup 5-6-7-8-9-10) olarak 4 ana kategoride (sırasıyla K-I, K-II, K-III, K-IV) değerlendirilmiştir. Reversible defekt (efor iskemisi) veya irreversible defekt (fiks defekt) olarak raporlanan tüm olgular, MPS(+) olarak değerlendirilmiştir. Bulgular: Hastaların %59'nun K-I'de (585/990), %24'nün K-II'de (237/990), %5,5'inin K-III'de (55/990) ve %11'inin (113/990) K-IV'de yer aldığı saptanmıştır. Toplam 990 hastanın %26.8'i (K-I= 83; K-II=58; K-III=28; K-IV=96) MPS(+) raporlanmıştır. Analiz sonucunda MPS tercihinin büyük ölçüde düşük risk grubunda (K-I) olduğu görülmüştür [MPS(+) oranı= %14]. Treadmill testi kuşkulu olan K-II olgularının %76'sı; yüksek riskli K-III olgularının %50'si normal olarak raporlanmıştır. Toplamda sadece %11 oranında bilinen KAH'nın sevk edilmiş olması, MPS'nin bu kategorideki yetersiz kullanımını göstermektedir. Sonuç: Yapılan retrospektif analizde bölgesel MPS endikasyonlarının büyük ölçüde KAH beklentisi düşük hastalarda tercih edildiği saptanmıştır. Miyokart perfüzyon sintigrafisinin, KAH riski orta derecede olan hastalarda ve KAH olgularında prognoz belirlemede kullanılması konusunda bilgilendirme çalışmalarının yapılmasının yararlı olacağı kanısına varıldı. Ülke genelinde planlanacak çalışmalar ile MPS kullanımının belirlenmesi, bu testin tanısal değerini arttıracak ve maliyet etkinliği açısından önemli kazanımlar sağlayacaktır.

Patient selection criteria in myocardial perfusion scintigraphy: A retrospective analysis of 990 regionally referred and single center reported cases

Although MPS is a well established imaging method in the diagnosis and prognostic stratification of coronary artery disease (CAD), its' current usage in our country hasn't yet been sufficiently studied. Material and Methods: Initially, the vague reports of 56/1046 (5%) patients were excluded. Remaining 990 (95%) patients (408 female, 54 ± 8 years; 582 men, 45 ± 10 years) were first sorted in 10 groups according to chest pain complaints, treadmill test, coronary angiography and were finally evaluated in four CAD expectation categories (CAD-E) as low (groups 1-2), intermediate (group 3), high (group 4) CAD-E patients (K-I, K-II and K-III, respectively) and known-CAD; K-IV (groups 5, 6, 7, 8, 9 and 10). All cases reported as reversible defect (ischemia) or irreversible defect were accepted as MPS (+). Results: The patients were distributed as 59%(585/990) in K-I, 24%(237/990) in K-II, 5%(55/990) in K-III and 11%(113/990) in K-IV. Of all 990 patients, 26.8%(K-I=83; K-II=58; K-III= 28; K-IV= 96) were reported as MPS(+). These results showed that the MPS was highly preferred in the low risk (KI) group [MPS(+) ratio=14%]. Seventy-six percent of K-II cases and 50%of K-III cases were reported as normal. The referral of only 11%of known-CAD patients indicated the inadequate use of MPS in this category. Conclusion: It was shown that MPS was used mostly in patients with low probability of CAD. It is demonstrated that MPS is not effectively used in a group of patients with intermediate probability of CAD and the prognostic stratification of patients with CAD in our region; thus informative wide scale workshops and seminars are required. It was also considered that this kind of national retrospective studies could be of great value in terms of more accurate diagnosis and cost-effectiveness.

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Turkish Journal of Nuclear Medicine (. Molecular Imaging and Radionuclide Therapy)-Cover

ISSN: 1304-1495
Yayın Aralığı: Yılda 4 Sayı
Başlangıç: 1992
Yayıncı: Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.