Journal of Nuclear Cardiology

, Volume 19, Issue 2, pp 311–318

Stress-only imaging in patients with prior SPECT MPI: A simulation study

  • John J. Ryan
  • Rupa Mehta
  • Thejasvi Thiruvoipati
  • R. Parker Ward
  • Kim Allan Williams
Original Article



The aim of this study was to determine if omitting the repeat resting scan in patients who had prior single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI) would have an impact on the interpretation of the stress test.


Current guidelines recommend stress and rest imaging for SPECT MPI studies. Stress-only imaging has also entered the guidelines as a feasible option in low-risk patients but has not been studied in high-risk patients.


Two independent readers interpreted 47 consecutive MPIs with prior images to determine if the repeat resting scan had an impact on interpretation of the stress test images. In this retrospective analysis, we compared interpretation of stress-only SPECT images using the old rest image for comparison versus conventional rest-stress SPECT imaging. Both readers were blinded to study results. The primary end point of this study was a comparison of summed difference scores (SDS) from stress-only interpretation compared to standard rest-stress interpretation.


In this study, 36% (98/272) of patients had previous SPECT MPI. Of these patients, 48% (n = 47) were eligible for stress-only imaging. There was strong agreement between the SDS from the new stress versus old rest image compared with the new stress versus new rest image (r = 0.866, P < .001) with a mean difference in SDS of 0.6 ± 1.7. In this population, 41 of the 47 studies (87%) could have been performed with a stress-only SPECT MPI with comparison with the prior resting study. Starting with the stress-only protocol would have reduced the radiation in this population by 76%.


Very similar data is obtained with stress-only imaging in patients who have a prior resting study. Our study suggests that the stress-only imaging may possibly be expanded to populations who have been studied previously or are at higher risk, reserving the option to add a resting study if the interpretation of the stress-only study is unclear.


Myocardial perfusion imaging: SPECT exercise: stress testing pharmacologic stress diagnostic and prognostic application radiation reduction 


  1. 1.
    Chang SM, Nabi F, Xu J, Raza U, Mahmarian JJ. Normal stress-only versus standard stress/rest myocardial perfusion imaging: Similar patient mortality with reduced radiation exposure. J Am Coll Cardiol 2010;55:221-30.PubMedCrossRefGoogle Scholar
  2. 2.
    Duvall WL, Wijetunga MN, Klein TM, et al. The prognosis of a normal stress-only Tc-99m myocardial perfusion imaging study. J Nucl Cardiol 2010;17:370-7.PubMedCrossRefGoogle Scholar
  3. 3.
    Klocke FJ, Baird MG, Lorell BH, 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). J Am Coll Cardiol 2003;42:1318-33.PubMedCrossRefGoogle Scholar
  4. 4.
    Thompson RC, Cullom SJ. Issues regarding radiation dosage of cardiac nuclear and radiography procedures. J Nucl Cardiol 2006;13:19-23.PubMedCrossRefGoogle Scholar
  5. 5.
    Hendel RC, Verani MS, Miller DD, et al. Diagnostic utility of tomographic myocardial perfusion imaging with technetium 99m furifosmin (Q12) compared with thallium 201: Results of a phase III multicenter trial. J Nucl Cardiol 1996;3:291-300.PubMedCrossRefGoogle Scholar
  6. 6.
    Reyes E, Loong CY, Harbinson M, et al. A comparison of Tl-201, Tc-99m sestamibi, and Tc-99m tetrofosmin myocardial perfusion scintigraphy in patients with mild to moderate coronary stenosis. J Nucl Cardiol 2006;13:488-94.PubMedCrossRefGoogle Scholar
  7. 7.
    Cerqueira MD, Nguyen P, Staehr P, Underwood SR, Iskandrian AE. Effects of age, gender, obesity, and diabetes on the efficacy and safety of the selective A2A agonist regadenoson versus adenosine in myocardial perfusion imaging integrated ADVANCE-MPI trial results. JACC Cardiovasc Imaging 2008;1:307-16.PubMedCrossRefGoogle Scholar
  8. 8.
    Hendel RC, Berman DS, Di Carli MF, et al. ACCF/ASNC/ACR/AHA/ASE/SCCT/SCMR/SNM 2009 appropriate use criteria for cardiac radionuclide imaging: A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the American Society of Nuclear Cardiology, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the Society of Cardiovascular Computed Tomography, the Society for Cardiovascular Magnetic Resonance, and the Society of Nuclear Medicine. Circulation 2009;119:e561-87.PubMedCrossRefGoogle Scholar
  9. 9.
    Einstein AJ, Weiner SD, Bernheim A, et al. Multiple testing, cumulative radiation dose, and clinical indications in patients undergoing myocardial perfusion imaging. J Am Med Assoc 2010;304:2137-44.CrossRefGoogle Scholar
  10. 10.
    Santana CA, Garcia EV, Vansant JP, et al. Gated stress-only 99mTc myocardial perfusion SPECT imaging accurately assesses coronary artery disease. Nucl Med Commun 2003;24:241-9.PubMedCrossRefGoogle Scholar
  11. 11.
    Holly TA, Abbott BG, Al-Mallah M, et al. Single photon-emission computed tomography. J Nucl Cardiol 2010;17:941-73.PubMedCrossRefGoogle Scholar
  12. 12.
    Des Prez R, Dahlberg S, Einstein A, et al. Stress-only myocardial perfusion imaging. J Nucl Cardiol 2009;16:329.CrossRefGoogle Scholar
  13. 13.
    Fazel R, Krumholz HM, Wang Y, et al. Exposure to low-dose ionizing radiation from medical imaging procedures. N Engl J Med 2009;361:849-57.PubMedCrossRefGoogle Scholar
  14. 14.
    Bateman TM, Heller GV, McGhie AI, et al. Multicenter investigation comparing a highly efficient half-time stress-only attenuation correction approach against standard rest-stress Tc-99m SPECT imaging. J Nucl Cardiol 2009;16:726-35.PubMedCrossRefGoogle Scholar
  15. 15.
    Eisenberg MJ, Afilalo J, Lawler PR, Abrahamowicz M, Richard H, Pilote L. Cancer risk related to low-dose ionizing radiation from cardiac imaging in patients after acute myocardial infarction. Can Med Assoc J 2011;183:430-6.CrossRefGoogle Scholar
  16. 16.
    Mahmarian JJ. Stress only myocardial perfusion imaging: Is it time for a change? J Nucl Cardiol 2010;17:529-35.PubMedCrossRefGoogle Scholar
  17. 17.
    O’Connor MK, Bothun E, Gibbons RJ. Influence of patient height and weight and type of stress on myocardial count density during SPECT imaging with thallium-201 and technetium 99m-sestamibi. J Nucl Cardiol 1998;5:304-12.PubMedCrossRefGoogle Scholar
  18. 18.
    Mahmood S, Gunning M, Bomanji JB, et al. Combined rest thallium-201/stress technetium-99m-tetrofosmin SPECT: Feasibility and diagnostic accuracy of a 90-minute protocol. J Nucl Med 1995;36:932-5.PubMedGoogle Scholar
  19. 19.
    DHHS Payment Policies Under the Physician Fee Schedule and other Revisions to Part B for CY 2010. 42 CFR Parts 410, 411, 414 et al.Google Scholar
  20. 20.
    Einstein AJ, Moser KW, Thompson RC, Cerqueira MD, Henzlova MJ. Radiation dose to patients from cardiac diagnostic imaging. Circulation 2007;116:1290-305.PubMedCrossRefGoogle Scholar
  21. 21.
    Shin JH, Pokharna HK, Williams KA, Mehta R, Ward RP. SPECT myocardial perfusion imaging with prone-only acquisitions: Correlation with coronary angiography. J Nucl Cardiol 2009;16:590-6.PubMedCrossRefGoogle Scholar

Copyright information

© American Society of Nuclear Cardiology 2012

Authors and Affiliations

  • John J. Ryan
    • 1
  • Rupa Mehta
    • 1
  • Thejasvi Thiruvoipati
    • 1
  • R. Parker Ward
    • 1
  • Kim Allan Williams
    • 2
  1. 1.Section of Cardiology, Department of MedicineUniversity of ChicagoChicagoUSA
  2. 2.Division of Cardiology, Department of Radiology, School of MedicineWayne State University School of Medicine, Harper University HospitalDetroitUSA

Personalised recommendations