European Journal of Nuclear Medicine

, Volume 24, Issue 2, pp 179–183 | Cite as

The occurrence of false-positive technetium-99m sestamibi bull's eye defects in different reference databases

A study of an age- and gender-stratified healthy population
  • Jens Toft
  • Birger Hesse
  • Alan Rabøl
Original Article

Abstract

Myocardial perfusion single-photon emission tomographic (SPET) imaging has been shown to be sensitive in the detection of coronary artery disease (CAD), whereas its specificity has been suboptimal. The aim of the present study was to study the frequency of abnormal bull's eye perfusion defects in a large age-stratified group of healthy subjects undergoing myocardial SPET assessed by comparison with two existing commercially available reference databases. One hundred and twenty-eight healthy volunteers (76 males and 52 females) with a less than 5% likelihood of CAD underwent rest and exercise technetium-99m sestamibi SPET. The false-positive response rate, defined as a significant reversible defect, was 12% when compared to the CEqual database and 29% when compared to the Cedars-Sinai database. With the CEqual program, rest defects occurred in 12% of the subjects. Defects occurred more often in women than in men, but the difference did not attain statistical significance. Significant defects were most frequent in the inferior wall and in women in the anterior wall as well. The distribution of defects was independent of age. Our results suggest that the specificity of99mTc-sestamibi myocardial SPET using commercially available reference files is suboptimal. The risk of obtaining a falsepositive test result in subjects undergoing99mTc-sestamibi myocardial SPET with a very low likelihood of CAD was higher than anticipated. With both reference files false-positive test results were most frequently observed in the inferior wall. Our data suggest that commercial reference files for myocardial SPET need to be optimised, and should be used with caution. The use of attenuation correction may prove to be a major step forward.

Key words

Technetium-99m sestamibi Coronary artery disease Reference databases Single-photon emission tomography 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Depasquale E, Nody A, Depuey E. Quantitative rotational thallium-201 tomography for identifying and localizing coronary artery disease.Circulation 1988; 77: 316–327.PubMedGoogle Scholar
  2. 2.
    Allman K, Berry J, Sucharski L, et al. Determination of extent and localisation of coronary artery disease in patients without prior infarction by thallium-201 tomography with pharmacologic stress.J Nucl Med 1992; 33: 609–618.Google Scholar
  3. 3.
    Van Train K, Garcia E, Maddahi J. Multicenter trial for quantitative analysis same-day rest stress technetium-99m-sestamibi tomograms.J Nucl Med 1994; 35: 609–618.PubMedGoogle Scholar
  4. 4.
    Gould K. How accurate is thallium exercise testing for the diagnosis of coronary artery disease?J Am Coll Cardiol 1989; 14: 1487–1490.PubMedCrossRefGoogle Scholar
  5. 5.
    Rozanski A, Diamond G, Forrester J, Berman A, Morris D, Swan H. Alternative referent standards for cardiac normality.Ann Intern Med 1984; 101: 165–171.Google Scholar
  6. 6.
    Van Train K, Arreda J, Garcia EV. Quantitative same-day rest stress technetium-99m sestamibi SPECT: definition and validation of stress normal limits and criteria for abnormality.J Nucl Med 1993; 34: 1494–1502.PubMedGoogle Scholar
  7. 7.
    Garcia E, Folks R, Cooke C, CEqual. 1992; CEqual manual.Google Scholar
  8. 8.
    Garcia E, Cooke D, Van Train K, et al. Technical aspects of myocardial SPECT imaging with technetium-99m sestamibi.Am J Cardiol 1990; 66: 23E-31E.PubMedCrossRefGoogle Scholar
  9. 9.
    Nyboe J, Jensen G, Appleyard M, Schnohr P. Risk factors for acute myocardial infarction in Copenhagen. I. Heriditary, educational and socioeconomic factors.Eur Heart J 1989; 10: 910–916.PubMedGoogle Scholar
  10. 10.
    Diamond G, Forrester J. Analysis of probability as aid in the clinical diagnosis of coronary artery disease.N Engl J Med 1979; 300: 1350–1358.PubMedCrossRefGoogle Scholar
  11. 11.
    Klein J, Garcia E, Depuey E. Reversibility bulls eye: a new polar map to quantify reversibility of stress induced SPECT thallium-201 myocardial perfusion defects.J Nucl Med 1990; 31: 1240–1246.PubMedGoogle Scholar
  12. 12.
    Ficaro E, Fessler J, Shreve P, Kritzman J, Rose P, Corbett J. Simultaneous Transmission/emission myocardial perfusion tomography.Circulation 1996; 85: 463–473.Google Scholar
  13. 13.
    Rozanski A. Assessment of the information bondoggle resulting from the evaluation of non-invasive stress test in cardiology.J Nucl Med 1995; 36: 1009–1013.PubMedGoogle Scholar
  14. 14.
    Van Train K, Siligan G, Kiat M. Non-circular vs. circular orbits in quantitative analysis of myocardial perfusion SPECT [abstract].J Nucl Med 1995; 36: 46.Google Scholar
  15. 15.
    Areeda M, Patterson H, Kiat G, et al. Correlative method for the evaluation of normal distributions in myocardial perfusion SPECT.J Nucl Med 1995; 36: 132–133.Google Scholar
  16. 16.
    Bourgignon M, Busemann Sokole E, Jones B, Wall E. Protocols for selection of radionuclide studies for use as a data base of normal studies and typical patterns of diseases.Eur J Nucl Med 1993; 20: 59–65.CrossRefGoogle Scholar
  17. 17.
    Baron J, Chouraqui P. Myocardial single-photon emission computed tomographic quality assurance.J Nucl Card 1996; 3: 157–166.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 1997

Authors and Affiliations

  • Jens Toft
    • 1
    • 2
  • Birger Hesse
    • 1
  • Alan Rabøl
    • 1
  1. 1.Department of Clinical Physiology and Nuclear MedicineNational University HospitalCopenhagenDenmark
  2. 2.Epidemiological Research Unit, RigshospitaletThe Copenhagen City Heart StudyCopenhagenDenmark

Personalised recommendations