PMID- 15100507
OWN - NLM
STAT- MEDLINE
DCOM- 20041130
LR  - 20191210
IS  - 0143-3636 (Print)
IS  - 0143-3636 (Linking)
VI  - 25
IP  - 5
DP  - 2004 May
TI  - Detection of stent restenosis in single vessel CAD: comparison of 201Tl and gated 
      99mTc-MIBI SPECT.
PG  - 479-86
AB  - BACKGROUND AND AIM: After successful percutaneous transluminal coronary 
      angioplasty (PTCA), stent restenosis is observed in up to 40% of patients during 
      the first year. The aim of this study was to determine the value of myocardial 
      perfusion studies (MPSs) in the detection of stent restenosis in a symptomatic 
      patient cohort. METHODS: A total of 80 patients without prior myocardial 
      infarction (MI) and who underwent one-vessel PTCA with stent implantation were 
      included to study. The diagnostic accuracy of two study protocols, Tl single 
      photon emission computed tomography (SPECT) (38 patients) and rest-stress same 
      day gated Tc sestamibi (MIBI) SPECT (42 patients), were compared. MPS data were 
      visually evaluated by two experienced observers and stress induced perfusion 
      defects with reversibility at rest was considered as restenosis. In gated MIBI 
      data the wall motion (WM) and ejection fraction (EF) were also noted. The 
      diagnostic value of a semiquantitative method based on 20 segment model and 
      summed stress scores (SSSs) and summed difference scores (SDSs) were also tested. 
      Results of MPSs were compared with control coronary angiography (CA) in all 
      patients and agreement was defined as the kappa value (kappa). RESULTS: The 
      average time between stent implantation and MPS was 8.9 +/- 2 months. Restenosis 
      was detected in 58% of patients in CA. No significant differences were observed 
      regarding age, gender, achieved exercise levels, vascular territorial 
      distribution of lesions, imaging time interval after PTCA and degree of 
      restenosis between Tl and gated MIBI groups. MPSs identified stent restenosis in 
      41 of 47 patients (sensitivity, 87%; specificity, 82%; accuracy, 85%; 
      kappa=0.69). Four of six occluded stents that could not be detected in MPSs 
      revealed intermediate degree stenosis (50-70%). Sensitivity, specificity and 
      accuracy were not significantly different but better for gated MIBI group when 
      compared to Tl (sensitivity, 90-83%; specificity, 85-80%; accuracy, 88-82%). 
      Semiquantitative evaluation using SSS and SDS reached lower sensitivity than 
      qualitative evaluation (MIBI, 90% vs 69%; Tl, 83% vs 72%) but higher specificity 
      (MIBI, 85% vs 92%; Tl, 80% vs 100%) for both tracers and SSS were significantly 
      correlated with occlusion degree (r=0.69). EF values calculated from the gated 
      MIBI study were also inversely correlated with occlusion degree (r=0.55) and 
      significantly different in patients with occluded stents (P<0.001). Agreement 
      with CA for both tests were adequate (kappa=0.73, for MIBI; and kappa=0.63, for 
      Tl). CONCLUSION: Semiquantitative evaluation of MPSs using SSS may enhance 
      diagnostic specificity in the detection of stent restenosis. Both Tl and gated 
      MIBI studies accurately detected stent restenosis. The gated MIBI method has 
      advantages of WM analysis and evaluation of EF.
FAU - Cingi, Elif
AU  - Cingi E
AD  - Department of Nuclear Medicine, Faculty of Medicine, Gazi University, Besevler, 
      06510 Ankara, Turkey.
FAU - Temiz, Nuh Hakan
AU  - Temiz NH
FAU - Yildirim, Nilufer
AU  - Yildirim N
FAU - Timurkaynak, Timur
AU  - Timurkaynak T
FAU - Cengel, Atiye
AU  - Cengel A
FAU - Unlu, Mustafa
AU  - Unlu M
LA  - eng
PT  - Clinical Trial
PT  - Comparative Study
PT  - Controlled Clinical Trial
PT  - Journal Article
PT  - Validation Study
PL  - England
TA  - Nucl Med Commun
JT  - Nuclear medicine communications
JID - 8201017
RN  - 0 (Radiopharmaceuticals)
RN  - 37CB58V15B (thallium chloride)
RN  - 971Z4W1S09 (Technetium Tc 99m Sestamibi)
RN  - AD84R52XLF (Thallium)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Angioplasty, Balloon, Coronary/*adverse effects
MH  - Blood Vessel Prosthesis/*adverse effects
MH  - Cohort Studies
MH  - Coronary Artery Disease/complications/*surgery
MH  - Female
MH  - Gated Blood-Pool Imaging/methods
MH  - Graft Occlusion, Vascular/*diagnostic imaging/etiology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Prognosis
MH  - Radiopharmaceuticals
MH  - Reproducibility of Results
MH  - Sensitivity and Specificity
MH  - Stents/*adverse effects
MH  - *Technetium Tc 99m Sestamibi
MH  - *Thallium
MH  - Tomography, Emission-Computed, Single-Photon/methods
EDAT- 2004/04/22 05:00
MHDA- 2004/12/16 09:00
CRDT- 2004/04/22 05:00
PHST- 2004/04/22 05:00 [pubmed]
PHST- 2004/12/16 09:00 [medline]
PHST- 2004/04/22 05:00 [entrez]
AID - 00006231-200405000-00009 [pii]
AID - 10.1097/00006231-200405000-00009 [doi]
PST - ppublish
SO  - Nucl Med Commun. 2004 May;25(5):479-86. doi: 10.1097/00006231-200405000-00009.