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Evaluation of the SPECT radioisotope perfusion scan in the detection of ischemic heart disease

Zdanowski Paweł, Cacko Marek, Rabczenko Daniel, Kochman Janusz, Królicki Leszek

Inżynier i Fizyk Medyczny

2022

Vol. 11, nr 2

129--135

Objectives: The aim of the study is to determine the diagnostic value of myocardial perfusion scintigraphy (MPS) depending on the location and size of stenosis of a coronary vessel or vessels. Methods: Results of examinations of patients hospitalized in two hospital departments of the same medical facility were analyzed. Retrospective research material consisted of results obtained for 200 patients with suspected ischemic heart disease (coronary artery disease - CAD). From this group, 83 examinations were selected where results of coronary angiography and perfusion scintigraphy (MPS) were available. The following tests were used for statistical studies: t-Student, Chi2, Fisher- -Sendecor, Kruskal-Wallis and Willcoxon. The use of these tests allowed for: – determination of predictive factors favoring development of ischemic heart disease in the analyzed group of patients, – determination of sensitivity and specificity of MPS, taking the coronary examination as the “gold standard”, – assessment of usefulness of the MPS imaging depending on location of a stenosis within the main coronary vessels, – evaluation of usefulness of MPS in detection of a multivessel disease. Results: I n t he a nalyzed g roup o f p atients, a rterial h ypertension was the main factor predisposing to CAD (p = 0.016). The highest sensitivity of MPS in the diagnosis of ischemia was found in the group of patients with stenosis of the right coronary artery (RCA) (p = 0.029) and the circumflex (Cx) and marginal (MB) branches (p = 0.028). A comparative analysis was performed between the degree of narrowing of the above vessels and the degree of perfusion disorders in the MPS study. There was a correlation between the severity of ischemia in MPS and the degree of stenosis in both RCA (p = 0.011, 95% sensitivity (83.1 - 99.4 CI; negative predictive value 83.3%) and the Cx/MB complex (p = 0.044, sensitivity 94.7% ( 83.1 - 99.4 CI), negative predictive value - 83.3%). There was a correlation between the result of the MPS perfusion scan and disease of two or three coronary vessels. There was a 97% agreement between the presence of permanent or transient defects in MPS and the presence of stenosis in 2 or 3 coronary vessels exceeding 80% of the vessel lumen. In the group of patients with stenosis ranging between 50-80%, abnormal results of the MPS occurred in 41.7% of patients. Conclusion: The results confirm that myocardial perfusion scintigraphy is a very valuable screening test in patients with suspected CAD. This examination shows high sensitivity also in the group of patients with multivessel disease.