Journal of Nuclear Cardiology

, Volume 25, Issue 2, pp 540–549 | Cite as

Analysis of stress-only imaging, comparing upright and supine CZT camera acquisition to conventional gamma camera images with and without attenuation correction, with coronary angiography as a reference

  • Zenith A. Jameria
  • Mouhamad Abdallah
  • Mariano Fernandez-Ulloa
  • Robert O’Donnell
  • Alok K. Dwivedi
  • Erica Washburn
  • Naseer Khan
  • Mahyar Khaleghi
  • Nischelle Kalakota
  • Myron C. Gerson
Original Article



Diagnostic performance of stress-only imaging using a Cadmium-Zinc-Telluride (CZT) camera has not been directly compared in the same patients to stress-only attenuation-corrected conventional Anger camera images.


112 subjects with correlative coronary angiographic data and 40 subjects with <5% pre-test likelihood of coronary disease completed attenuation-corrected stress-only images on a conventional Anger camera and uncorrected upright and supine stress images on a CZT camera. Two readers provided independent, blinded interpretations of stress-only images.


Upright and supine stress-only CZT images and attenuation-corrected Anger camera images provided similar positive (reader 1/reader 2, 50.0%/44.1% vs 46.4%/51.9%) and negative (66.7%/64.0% vs 67.9%/67.7%) predictive values (all P = NS) for obstructive coronary artery disease; however, the sensitivity was higher (81.3% vs 58.3%, P = .05), specificity lower (29.7% vs 50.0%, P = .005), and normalcy rate lower (87.5% vs 100%, P = .025) with attenuation-corrected Anger camera images for the first reader with no significant differences between cameras for the second reader.


Stress-only upright and supine CZT imaging was non-inferior statistically to attenuation-corrected stress-only Anger camera imaging. Nevertheless, stress-only CZT imaging may be associated with reduced diagnostic sensitivity for some readers compared to attenuation-corrected Anger camera images, which may be less acceptable clinically compared to stress plus rest images.


Myocardial perfusion imaging Stress-only Cadmium-zinc-telluride 



Confidence intervals


Coronary artery disease




Left ventricular ejection fraction


Myocardial perfusion imaging


Negative predictive value


Positive predictive value


Relative risk ratio


Single-photon emission computerized tomography


Summed stress score



Drs. Jameria, Abdallah, Fernandez-Ulloa, O'Donnell, Dwivedi, Khan, Khaleghi, and Gerson, and Authors Washburn and Kalakota have no conflicts of interest to disclose.

Supplementary material

12350_2017_781_MOESM1_ESM.docx (21 kb)
Supplementary material 1 (DOCX 21 kb)


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Copyright information

© American Society of Nuclear Cardiology 2017

Authors and Affiliations

  • Zenith A. Jameria
    • 1
  • Mouhamad Abdallah
    • 2
  • Mariano Fernandez-Ulloa
    • 3
  • Robert O’Donnell
    • 2
  • Alok K. Dwivedi
    • 4
  • Erica Washburn
    • 3
  • Naseer Khan
    • 2
  • Mahyar Khaleghi
    • 2
  • Nischelle Kalakota
    • 5
  • Myron C. Gerson
    • 2
  1. 1.Division of Cardiology, Department of Internal MedicineUniversity of Illinois at ChicagoChicagoUSA
  2. 2.Division of Cardiology, Department of Internal MedicineUniversity of Cincinnati Medical CenterCincinnatiUSA
  3. 3.Division of Nuclear Medicine, Department of RadiologyUniversity of Cincinnati Medical CenterCincinnatiUSA
  4. 4.Division of Biostatistics and Epidemiology, Department of Biomedical SciencesTexas Tech University Health Sciences CenterEl PasoUSA
  5. 5.University of Cincinnati College of MedicineCincinnatiUSA

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