Journal of Nuclear Cardiology

, Volume 16, Issue 4, pp 590–596 | Cite as

SPECT myocardial perfusion imaging with prone-only acquisitions: correlation with coronary angiography

  • John H. Shin
  • Hemlata K. Pokharna
  • Kim A. Williams
  • Rupa Mehta
  • R. Parker Ward
Original Article

Abstract

Background

Recent evidence suggests that combining supine and prone acquisitions during stress-gated SPECT myocardial perfusion imaging (MPS) improves detection of obstructive coronary artery disease (CAD), though the additional imaging time required may not be feasible in routine clinical practice. MPS with prone-only acquisitions is occasionally performed in many laboratories, though little is known about the ability of modern MPS with prone-only acquisitions to detect obstructive CAD. Our goal was to assess the ability of MPS with prone-only acquisitions to detect obstructive CAD as determined by coronary angiography.

Methods and Results

We studied 386 patients referred for MPS with either recent coronary angiography or a low pretest likelihood of coronary artery disease. All rest and stress images were obtained exclusively in the prone position. The sensitivity of prone-only MPS was 88% for detecting ≥50% coronary artery stenosis and 92% for detecting ≥70% coronary artery stenosis as determined by coronary angiography. Normalcy rate for prone-only MPS in patients with low probability for CAD was 95%, and normalcy rates did not significantly differ among coronary artery distributions.

Conclusions

The findings of this study suggest that MPS using prone-only acquisitions is a reasonable diagnostic option for the detection of ischemia due to obstructive coronary artery disease.

Keywords

Myocardial perfusion imaging: SPECT diagnostic and prognostic application coronary artery disease ischemia myocardial 

References

  1. 1.
    Hansen CL, Goldstein RA, Akinboboye OO, Berman DS, Botvinick EH, Churchwell KB, et al. Myocardial perfusion and function: Single photon emission computed tomography. J Nucl Cardiol 2007;14:e39-60.CrossRefPubMedGoogle Scholar
  2. 2.
    DePuey EG 3rd. How to detect and avoid myocardial perfusion SPECT artifacts. J Nucl Med 1994;35:699-702.PubMedGoogle Scholar
  3. 3.
    Nishina H, Slomka PJ, Abidov A, Yoda S, Akincioglu C, Kang X, et al. Combined supine and prone quantitative myocardial perfusion SPECT: Method development and clinical validation in patients with no known coronary artery disease. J Nucl Med 2006;47:51-8.PubMedGoogle Scholar
  4. 4.
    Segall GM, Davis MJ, Goris ML. Improved specificity of prone versus supine thallium SPECT imaging. Clin Nucl Med 1988;13:915-6.CrossRefPubMedGoogle Scholar
  5. 5.
    Esquerré JP, Coca FJ, Martinez SJ, Guiraud RF. Prone decubitus: A solution to inferior wall attenuation in thallium-201 myocardial tomography. J Nucl Med 1989;30:398-401.PubMedGoogle Scholar
  6. 6.
    Segall GM, Davis MJ. Prone versus supine thallium myocardial SPECT: A method to decrease artifactual inferior wall defects. J Nucl Med 1989;30:548-55.PubMedGoogle Scholar
  7. 7.
    Kiat H, Van Train KF, Friedman JD, Germano G, Silagan G, Wang FP, et al. Quantitative stress-redistribution thallium-201 SPECT using prone imaging: Methodologic development and validation. J Nucl Med 1992;33:1509-15.PubMedGoogle Scholar
  8. 8.
    Slomka PJ, Nishina H, Abidov A, Hayes SW, Friedman JD, Berman DS, et al. Combined quantitative supine-prone myocardial perfusion SPECT improves detection of coronary artery disease and normalcy rates in women. J Nucl Cardiol 2007;14:44-52.CrossRefPubMedGoogle Scholar
  9. 9.
    Berman DS, Kang X, Nishina H, Slomka PJ, Shaw LJ, Hayes SW, et al. Diagnostic accuracy of gated Tc-99m sestamibi stress myocardial perfusion SPECT with combined supine and prone acquisitions to detect coronary artery disease in obese and nonobese patients. J Nucl Cardiol 2006;13:191-201.PubMedGoogle Scholar
  10. 10.
    Hayes SW, De Lorenzo A, Hachamovitch R, Dhar SC, Hsu P, Cohen I, et al. Prognostic implications of combined prone and supine acquisitions in patients with equivocal or abnormal supine myocardial perfusion SPECT. J Nucl Med 2003;44:1633-40.PubMedGoogle Scholar
  11. 11.
    Diamond GA, Forrester JS. Analysis of probability as an aid in the clinical diagnosis of coronary artery disease. N Engl J Med 1979;300:1350-8.PubMedGoogle Scholar
  12. 12.
    Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS, et al. ACC/AHA 2002 guideline update for the management of patients with chronic stable angina—summary article: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina). Circulation 2003;107:149-58.CrossRefPubMedGoogle Scholar
  13. 13.
    Gibbons RJ, Balady GJ, Bricker JT, Chaitman BR, Fletcher GF, Froelicher VF, et al. ACC/AHA 2002 guideline update for exercise testing: Summary article: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). Circulation 2002;106:1883-92.CrossRefPubMedGoogle Scholar
  14. 14.
    Brindis RG, Douglas PS, Hendel RC, Peterson ED, Wolk MJ, Allen JM, et al. ACCF/ASNC appropriateness criteria for single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI): A report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group and the American Society of Nuclear Cardiology. J Am Coll Cardiol 2005;46:1587-605. Review. Erratum in: J Am Coll Cardiol 2005;46(11):2148-50.CrossRefPubMedGoogle Scholar
  15. 15.
    Shaw LJ, Peterson ED, Shaw LK, Kesler KL, DeLong ER, Harrell FE Jr, et al. Use of a prognostic treadmill score in identifying diagnostic coronary disease subgroups. Circulation 1998;98:1622-30.PubMedGoogle Scholar
  16. 16.
    Klocke FJ, Baird MG, Lorell BH, Bateman TM, Messer JV, Berman DS, et al. ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging—executive summary: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASNC Committee to Revise the 1995 Guidelines for the Clinical Use of Cardiac Radionuclide Imaging). Circulation 2003;108:1404-18.CrossRefPubMedGoogle Scholar
  17. 17.
    Perault C, Loboguerrero A, Liehn JC, Wampach H, Gibold C, Ouzan J, et al. Quantitative comparison of prone and supine myocardial SPECT MIBI images. Clin Nucl Med 1995;20:678-84.CrossRefPubMedGoogle Scholar

Copyright information

© American Society of Nuclear Cardiology 2009

Authors and Affiliations

  • John H. Shin
    • 1
  • Hemlata K. Pokharna
    • 1
  • Kim A. Williams
    • 1
  • Rupa Mehta
    • 1
  • R. Parker Ward
    • 1
  1. 1.Section of Cardiology, Department of MedicineUniversity of Chicago, University of Chicago HospitalsChicagoUSA

Personalised recommendations