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High-efficiency SPECT MPI: Comparison of automated quantification, visual interpretation, and coronary angiography

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Recently introduced high-efficiency (HE) SPECT cameras with solid-state CZT detectors have been shown to decrease imaging time and reduce radiation exposure to patients. An automated, computer-derived quantification of HE MPI has been shown to correlate well with coronary angiography on one HE SPECT camera system (D-SPECT), but has not been compared to visual interpretation on any of the HE SPECT platforms.

Methods

Patients undergoing a clinically indicated Tc-99m sestamibi HE SPECT (GE Discovery 530c with supine and prone imaging) study over a 1-year period followed by a coronary angiogram within 2 months were included. Only patients with a history of CABG surgery were excluded. Both MPI studies and coronary angiograms were reinterpreted by blinded readers. One hundred and twenty two very low (risk of CAD < 5%) or low (risk of CAD < 10%) likelihood subjects with normal myocardial perfusion were used to create normal reference limits. Computer-derived quantification of the total perfusion deficit at stress and rest was obtained with QPS software. The visual and automated MPI quantification were compared to coronary angiography (≥70% luminal stenosis) by receiver operating curve (ROC) analysis.

Results

Of the 3,111 patients who underwent HE SPECT over a 1-year period, 160 patients qualified for the correlation study (66% male, 52% with a history of CAD). The ROC area under the curve (AUC) was similar for both the automated and the visual interpretations using both supine only and combined supine and prone images (0.69-0.74). Using thresholds determined from sensitivity and specificity curves, the automated reads showed higher specificity (59%-67% vs 27%-60%) and lower sensitivity (71%-72% vs 79%-93%) than the visual reads. By including prone images sensitivity decreased slightly but specificity increased for both. By excluding patients with known CAD and cardiomyopathies, AUC and specificity increased for both techniques (0.72-0.82). The use of a difference score to evaluate ischemic burden resulted in lower sensitivities but higher specificities for both automated and visual quantification. There was good agreement between the visual interpretation and automated quantification in the entire cohort of 160 unselected consecutive patients (r = 0.70-0.81, P < .0001).

Conclusions

Automated and visual quantification of high-efficiency SPECT MPI with the GE Discovery camera provides similar overall diagnostic accuracy when compared to coronary angiography. There was good correlation between the two methods of assessment. Combined supine and prone stress imaging provided the best diagnostic accuracy.

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Acknowledgements

This research was supported in part by Grant R0HL089765-05 from the National Heart, Lung, and Blood Institute/National Institutes of Health (NHLBI/NIH). Cedars-Sinai Medical Center receives royalties for the licensure of quantitative perfusion software, a portion of which is distributed to one of the authors (PS) of this manuscript.

Addendum

The patients analyzed in this study were also included in an earlier study which correlated CZT SPECT MPI to coronary angiography irrespective of tracer (Tc-99m or Tl-201).21

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Authors and Affiliations

  1. Mount Sinai Division of Cardiology (Mount Sinai Heart), Mount Sinai Medical Center, P.O. Box 1030, One Gustave L Levy Place, New York, NY, 10029, USA

    W. Lane Duvall MD, Joseph M. Sweeny MD, Usman Baber MD, Lori B. Croft MD, Krista A. Guma CNMT, Titus George CNMT & Milena J. Henzlova MD

  2. Artificial Intelligence in Medicine Program, Cedars-Sinai Medical Center, New York, NY, USA

    Piotr J. Slomka PhD & Jim R. Gerlach CNMT

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  1. W. Lane Duvall MD
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  2. Piotr J. Slomka PhD
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  3. Jim R. Gerlach CNMT
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  4. Joseph M. Sweeny MD
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  5. Usman Baber MD
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  6. Lori B. Croft MD
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  7. Krista A. Guma CNMT
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  8. Titus George CNMT
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  9. Milena J. Henzlova MD
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Corresponding author

Correspondence to W. Lane Duvall MD.

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Duvall, W.L., Slomka, P.J., Gerlach, J.R. et al. High-efficiency SPECT MPI: Comparison of automated quantification, visual interpretation, and coronary angiography. J. Nucl. Cardiol. 20, 763–773 (2013). https://doi.org/10.1007/s12350-013-9735-x

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  • DOI: https://doi.org/10.1007/s12350-013-9735-x

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