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Myocardial perfusion scintigraphy in the diagnosis of Ischemic Heart Disease
VŠOLKOVÁ, Marta
Abstract Radionuclide examination of coronary arteries - myocardial perfusion scintigraphy using a method of a single-photon emission computed tomography ( SPECT ) - provides by a non-invasive way functional information which is complementary to morphologic information gained by an invasive selective coronary angiography. However, the examination of cardiac arteries in the diagnostics of ischemic heart disease (IHD) is carried out by means of other examination procedures which are together in a mutual interaction. Therefore, apart from the basic anatomy and physiology of the coronary arteries and pathophysiology of IHD, the section of the theoretical part of the work also provides an overview of examination methods which are in relation to the radiology assistant´s work. The methods used to diagnose IHD are divided into non-invasive stress tests and invasive diagnostic and therapeutic methods. Among the non-invasive stress tests are: ergometer stress test, ECG Holter monitoring, echocardiography examination, stress cardiac mag-netic resonance imaging, myocardial perfusion scintigraphy, 18F-FDG PET, CT angi-ography, CT determination of calcium score, and optical coherence tomography. The category of invasive diagnostic and therapeutic method includes: selective coronary angi-ography, PTCA, and CABG. Detailed description of SPECT myocardial perfusion scin-tigraphy is described in a separate chapter. Objective of the practical part of the work was to compare the conclusions of SPECT myocardial perfusion scintigraphy results with the conclusions of coronary angiography results. I looked for answers to the two following research issues: 1.Would the conclusions of myocardial perfusion scintigraphy examination medical report differ from the conclusions of coronary angiography medical report maximally by 10%? 2. Would be the non-corresponding results different in men and women? Methodology: In the medical files of patients who were recommended for coronary an-giography after myocardial scintigraphy I looked up the final medical reports on their coronary angiography findings. The patients with negative scintigraphy findings who underwent shortly after myocardial scinfigraphy selective coronary angiography with positive results were also included into the group. Group of patients: From January 2013 to September 2013 a group of patients underwent stress myocardial scintigraphy examination at the CNM in Prague. In total there were 619 patients - 344 men and 275 women. 187 patients underwent an additional rest myocardial perfusion scintigraphy. There were positive findings in 86 of these patients with referral for coronary angiography. Backward search proved impossible to find coronary angi-ography results in 19 patients. Nevertheless, 3 patients with false-negative scintigraphy findings were included into the group. The resulting group thus consists of 70 patients 23 women and 47 men. Results: The results of SPECT myocardial perfusion scintigraphy and coronary angi-ography differ in 13% which slightly exceeds the limit of 10% set in the research issue. Two thirds of non-corresponding scintigraphy results were false-positive, one third false-negative. With regards to the second research issue I came to the conclusion that in the detection of IHD the number of non-corresponding result of SPECT myocardial scintigraphy and cor-onary angiography is identical in both genders. There was 13 % of non-corresponding findings in women and 12.7 % of non-corresponding findings in men.
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