五洲会何作祥核心脏病学现状与进展a课件.pptVIP

心肌灌注显像正常与异常的冠状动脉再血管化治疗比例（N=1053） * P0.001 Han PP, et al. Chin J Med 2011 (in press) * * * * * * * * * * * * * * 戴飞增 女 41岁 腺苷负荷/静息心肌灌注显像：左室心尖、前壁心肌缺血。 * * * * * * IAEA Training Material on Radiation Protection in Nuclear Medicine Radiation protection in nuclear medicine * * * * * * * The increased specificity of technetium-99m sestamibi gated SPECT for the detection of CAD in women was shown in a study by Taillefer et al.1 The researchers compared the sensitivity and specificity of stress thallium-201 and technetium-99m sestamibi SPECT for the detection of CAD in 115 women—85 patients with suspected CAD who were scheduled for coronary angiography and 30 volunteers with a low (5%) likelihood of CAD. Both studies were done within 1 week; exercise and pharmacologic stress were used. Overall sensitivity for detecting stenosis 350% (n = 64) was 75.0% for thallium and 71.9% for technetium-99m-sestamibi; the sensitivity for detecting stenosis 370% (n = 51) was 84.3% and 80.4%, respectively (not significantly different). However, the specificity for lesions 350% was 70.6% for thallium and 86.3% for technetium-99m-sestamibi (p=0.05); gating increased the specificity of technetium-99m sestamibi to 94.1% (p=0.002 compared with thallium-210 imaging). For lesions 370%, the specificity was 67.2% for thallium and 84.4% for technetium-99m sestamibi SPECT (p=0.02); gating improved the specificity in this group to 92.2% (p=0.0004 compared with thallium). Taillefer et al concluded that thallium and technetium-99m sestamibi have a similar sensitivity for the detection of CAD in women but that technetium-99m sestamibi has a significantly greater specificity, which gating increases even further.1 This conclusion is in agreement with earlier work by DePuey and Rozanski, which showed that gating improves the specificity of technetium-99m sestamibi SPECT.2 1. Taillefer R, DePuey EG, Udelson J, Beller GA, Latour Y, Reeves F. Comparative diagnostic accuracy of thallium-201 and Tc-99m sestamib