Validierung der Myokardperfusionsszintigraphie mit 99m-Technetium-Tetrofosmin mit Hilfe von ROC-Analysen im Rahmen des Qualitätsmanagements der Klinik für Nuklearmedizin

OBJECTIVE: In the 1970s and 80s 201-thallium chloride and 99m-technetium Sestamibi was used in nuclear medicine. In the 90s 99m-technetium Tetrofosmin became available on the market. It was also utilized in the department of nuclear medicine at Philipp’s University in Marburg, but an evaluation was still missing. The task of this thesis was to validate the use of 99m-technetium Tetrofosmin for quality management. Furthermore the computer programme MyoSpect® by Segami should be tested. METHODS: A database was designed, in which 198 patients were stored. The examination period was from February 6, 2002 to August 8, 2003. The results of coronary angiographies, performed by internal physicians, myocardium perfusion scintigraphies and clinical inspection were registered. There were no age limitations for the inclusion criteria of the study. People were excluded who had undergone procedures of cardiac operation, bypass surgery, stent implantation in the past. The aim of the study was to evaluate scintigraphy for clinical routine diagnostic before invasive measures take place. For biometric analyses ROC (Receiver Operator Characteristic) was used. As a threshold was determined whether scintigraphies are valued as pathological or inconspicuous. These were compared with the results from the angiographies. We considered vessel localization (LAD, LCX, and RCA) and main vessels or secondary vessels. RESULTS: In comparison with the results of the angiographies, at a stenosis of the coronary arteries of 50% a sensitivity of 64% was achieved with a specificity of 69%, when both main and secondary vessels were evaluated. A higher sensitivity was achieved (68%) at a stenosis of 70% while the specificity sank to 66%. In regard only onto the main vessels the values vary onto a sensitivity of 65% and a specificity of 68% at a stenosis of 50%. At a stenosis of 70% the specificity was lowered to 64%, the sensitivity went up onto 67%. CONCLUSIONS: For the work with MyoSpect® it can be stated that the programme is simply to use and its handling proved as time-effective. The results are reproducible at any time. 99m-technetium Tetrofosmin shows good results in the diagnostic and localization of coronary less perfusion in the clinical routine. A high correlation with the clinical findings is ascertained. Suggestions can be made e. g. with regards to invasive interventions.