Diagnostic assessment of optimized-qualiative and quantitative 99mTc-MIBI planar perfusion myocardial scintigrams analysis in the detection of coronary artery diseases
Jacek Kuśmierek, Anna Płachcińska, Małgorzata Bieńkiewicz, Maciej Kośmider
Med Sci Monit 1999; 5(2): MT324-332
The aim of this study was to verify the adequacy of the diagnostic criterion applied in previously described quantitative planar scintigraphic methods of coronary artery disease detection, as well as to develop, optimize and determine the diagnostic value of the scintigraphic method in the detection of this disease based on qualitative and quantitative heart scintigrams. The study group comprised 304 patients with a suspected coronary heart disease, with no history of a previous myocardial infarction. Group I comprised 197 patients (65 females and 132 males), divided into two independent subgroups, IA and IB, comprising 90 and 107 patients, respectively. In group I patients, scintigraphic findings were verified by means of coronary angiography. Group II comprised 107 patients (67 females and 40 males) with a low (<10) initial probability of coronary disease, who were not subject to coronary angiography. On the basis of examinations performed in subgroup IA, we optimized the qualitative and quantitative criteria of myocardial perfusion evaluation. Adequacy of selected criteria was analysed on the basis of findings obtained from subgroup IB, comparing sensitivity, specificity and accuracy indices obtained from both groups. During qualitative evaluation they amounted respectively to 89.74 and 80% in IA and 86.72 and 79% in IB (no statistically significant differences), while during quantitative evaluation they equalled 86.87 and 87% in IA and 84.84 and 84% in IB (no statistically significant differences), respectively. Comparison of qualitative and quantitative results indicated a significantly higher (p<0.05) specificity of the quantitative method in both group I subgroups. During the second stage the previously optimized diagnostic criteria were applied in order to compare basic diagnostic efficacy indices for the qualitative, quantitative and combined methods, separately in the female (n=65) and male (n=132) groups. The quantitative evaluation of scintigrams in women and combined in men yielded optimal results in the diagnostics of coronary artery diseases. Sensitivity, specificity and accuracy in women amounted to 81.84 and 83%, while in men 95.82 and 89%, respectively. A significantly higher (p<0.05) sensitivity was noted in men. Normality rate values obtained on the basis of group II patient investigations were high - 91% in females and 93% in males. Methods of scintigrams evaluation different for each sex, allow to obtain optimized, high diagnostic efficacy indicesof planar perfusion scintigraphy in the diagnostics of coronary artery diseases.
Keywords: myocardial perfusion scintigraphy, technetium-99mTc methoxyisobutylisonitrile, planar scintigraphy, Coronary Artery Disease, optimization