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Inicio Revista Española de Medicina Nuclear e Imagen Molecular (English Edition) SPECT, coronary angio-CT, invasive coronary angiography and fusion images in sta...
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Vol. 34. Issue 3.
Pages 173-180 (May - June 2015)
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Vol. 34. Issue 3.
Pages 173-180 (May - June 2015)
Original Article
SPECT, coronary angio-CT, invasive coronary angiography and fusion images in stable coronary disease
SPECT, angio-TC coronaria, coronariografía invasiva e imágenes de fusión en la cardiopatía isquémica estable
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M.N. Pizzia,
Corresponding author
nachi_pizzi@yahoo.com.ar

Corresponding author.
, S. Aguadé-Bruixb, A. Roquec, H. Cuéllar-Calabriac, G. Romero-Farinaa, B. García del Blancoa, J. Castell-Conesab, D. García-Doradoa, J. Candell-Rieraa
a Servicio de Cardiología, Hospital Universitari Vall d’Hebron, Institut de Recerca (VHIR), Universitat Autónoma de Barcelona, Barcelona, Spain
b Servicio de Medicina Nuclear, Hospital Universitari Vall d’Hebron, Institut de Recerca (VHIR), Universitat Autónoma de Barcelona, Barcelona, Spain
c Servicio de Radiología, Hospital Universitari Vall d’Hebron, Institut de Recerca (VHIR), Universitat Autónoma de Barcelona, Barcelona, Spain
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Tables (5)
Table 1. Clinical, ergometric characteristics of gated-SPECT, coronary CT and invasive coronary angiography.
Table 2. Revascularized patients with one-vessel disease.
Table 3. Revascularized patients with 2-vessel disease.
Table 4. Revascularized patients with 3-vessel disease.
Table 5. Patients under medical treatment.
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Abstract
Objectives

To evaluate the usefulness of the information obtained with SPECT, coronary angio-CT and fusion images, in patients with stable ischemic disease who need invasive coronary angiography (IA).

Material and methods

Forty-six patients (65.98±8.3 years) with coronary disease were prospectively included. The fusion images generated after undergoing IA were used to evaluate the performance of these techniques in the diagnosis of multi-vessel coronary disease, the detection of the culprit vessel and the therapeutic management of these patients.

Results

In the IA, 29 of the 46 patients (63%) had multi-vessel disease. SPECT could detect it in 48.2% and coronary angio-CT could detect it in 89.6%. Concordance between coronary angio-CT and IA in the diagnosis of the culprit vessel was 77% (kappa 0.6), and between SPECT and IA it was 73% (kappa 0.56). Although fusion images could have been obtained prior to IA, they would not have changed the therapeutic approach derived from SPECT and IA.

Conclusions

Coronary angio-CT has a high ability for the diagnosis of multi-vessel disease and the culprit lesion, and SPECT is a good functional complement of the IA in the detection of the most ischemic territory. However, the performance of fusion images in patients with stable ischemic disease, who have undergone a SPECT as the first non-invasive study and need IA, does not seem indicated because they would not have changed the therapeutic management derived from SPECT and IA information.

Keywords:
Stable ischemic disease
Multi-vessel disease
Gated-SPECT
Coronary angio-CT
SPECT-CT image fusion
Culprit vessel
Resumen
Objetivos

Valorar la información de la SPECT, de la angio-TC coronaria y de las imágenes híbridas de fusión en los pacientes con cardiopatía isquémica estable en los que se practica una coronariografía invasiva (CI).

Material y métodos

Se ha incluido en forma prospectiva a 46 pacientes (65,98±8,3 años) con enfermedad coronaria, valorándose la información de dichas técnicas en el diagnóstico de la enfermedad multivaso, en la detección del vaso culpable y en el manejo de los pacientes.

Resultados

En la CI, 29 de los 46 pacientes (63%) presentaban enfermedad multivaso: la SPECT la diagnosticó en un 48,2% y la angio-TC en un 89,6%. La concordancia entre la angio-TC y la CI en el diagnóstico del vaso culpable fue del 77% (kappa 0,6) y entre la SPECT y la CI del 73% (kappa 0,56). Las imágenes híbridas obtenidas después del cateterismo no habrían aportado nueva información a la ya obtenida mediante la SPECT y la CI de cara al manejo terapéutico.

Conclusiones

La angio-TC destaca en el diagnóstico de la enfermedad multivaso y en la detección del vaso culpable respecto a la CI. La SPECT resulta un buen complemento funcional de la CI en la detección del territorio más isquémico. No obstante, en los pacientes con cardiopatía isquémica estable en los que se ha realizado una SPECT como primer estudio no invasivo, si la decisión de practicar posteriormente una CI es clara, la realización de una angio-TC y la obtención de imágenes de fusión SPECT-TC no parecen indicadas, ya que no cambiaría el manejo terapéutico que se adopta sobre la base de la información de la SPECT y la CI.

Palabras clave:
Cardiopatía isquémica estable
Enfermedad multivaso
Gated-SPECT
Angio-TC
Fusión SPECT-TC
Vaso culpable

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