Lancet：心脏MRI检查优于SPECT
2011-12-24 巩睿智 生物谷
英国利兹大学的John P. Greenwood博士等近日在《柳叶刀》（The Lancet）发表论文称，心脏MRI在诊断冠状动脉性心脏病方面优于单光子发射CT（SPECT）性应力心急灌流显像。 心脏MRI的灵敏度和阴性预测值分别为86.5%和90.5%，显着高于SPECT的66.5%和79.1%。 这项名为"冠状动脉性心脏病磁共振成像临床评估"（CE-MARC）的研究，包含了752名疑似心绞
英国利兹大学的John P. Greenwood博士等近日在《柳叶刀》（The Lancet）发表论文称，心脏MRI在诊断冠状动脉性心脏病方面优于单光子发射CT（SPECT）性应力心急灌流显像。
心脏MRI的灵敏度和阴性预测值分别为86.5%和90.5%，显着高于SPECT的66.5%和79.1%。
这项名为"冠状动脉性心脏病磁共振成像临床评估"（CE-MARC）的研究，包含了752名疑似心绞痛并有至少1种心血管事件危险因素的患者，这项患者均接受了心脏MRI、SPECT及冠状动脉造影3项检查。
冠脉造影结果显示，共有39%的患者有明显的冠状动脉性心脏病。
与灵敏度和阴性预测值不同，尽管心脏MRI其他诊断精确度指标在数值上均较高，但其并未显示出与SPECT有显着差异：心脏MRI的诊断特异性和阳性预测值分别为83.4%和77.2%，SPECT为82.6%和71.4%。
此外，应力灌注心脏MRI对单支和多支冠状动脉性心脏病的诊断也均优于SPECT，其曲线下面积分别为0.87和0.91比0.71和0.77。
作者称，SPECT现已成为评估心肌缺血最为广泛的方法，但该方法有一些缺点，如电离辐射等。而这一发现有助于心脏MRI检查的推广。
但美国西北大学的Robert O. Bonow博士也指出，诊断的精确度的确是一个很重要的方面，但该检查的价格及可行性也不容忽视。而且更检查的精确度提高是否能改善患者预后也值得考虑。（生物谷bioon.com）
Cardiovascular magnetic resonance and single-photon emission computed tomography for diagnosis of coronary heart disease (CE-MARC): a prospective trial
Dr John P Greenwood PhD, Neil Maredia MBChB , John F Younger MBChB , Prof Julia M Brown MSc , Prof Jane Nixon PhD, Colin C Everett MSc , Petra Bijsterveld MA , John P Ridgway PhD , Aleksandra Radjenovic PhD , Catherine J Dickinson PhD, Prof Stephen G Ball PhD , Sven Plein PhD.
Background
In patients with suspected coronary heart disease, single-photon emission computed tomography (SPECT) is the most widely used test for the assessment of myocardial ischaemia, but its diagnostic accuracy is reported to be variable and it exposes patients to ionising radiation. The aim of this study was to establish the diagnostic accuracy of a multiparametric cardiovascular magnetic resonance (CMR) protocol with x-ray coronary angiography as the reference standard, and to compare CMR with SPECT, in patients with suspected coronary heart disease.
Methods
In this prospective trial patients with suspected angina pectoris and at least one cardiovascular risk factor were scheduled for CMR, SPECT, and invasive x-ray coronary angiography. CMR consisted of rest and adenosine stress perfusion, cine imaging, late gadolinium enhancement, and MR coronary angiography. Gated adenosine stress and rest SPECT used 99mTc tetrofosmin. The primary outcome was diagnostic accuracy of CMR. This trial is registered at controlled-trials.com, number ISRCTN77246133.
Findings
In the 752 recruited patients, 39% had significant CHD as identified by x-ray angiography. For multiparametric CMR the sensitivity was 86·5% (95% CI 81·8-90·1), specificity 83·4% (79·5-86·7), positive predictive value 77·2%, (72·1-81·6) and negative predictive value 90·5% (87·1-93·0). The sensitivity of SPECT was 66·5% (95% CI 60·4-72·1), specificity 82·6% (78·5-86·1), positive predictive value 71·4% (65·3-76·9), and negative predictive value 79·1% (74·8-82·8). The sensitivity and negative predictive value of CMR and SPECT differed significantly (p<0·0001 for both) but specificity and positive predictive value did not (p=0·916 and p=0·061, respectively).
Interpretation
CE-MARC is the largest, prospective, real world evaluation of CMR and has established CMR's high diagnostic accuracy in coronary heart disease and CMR's superiority over SPECT. It should be adopted more widely than at present for the investigation of coronary heart disease.
Funding
British Heart Foundation.
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