Document Detail

Attenuation correction reveals gender-related differences in the normal values of transient ischemic dilation index in rest-exercise stress sestamibi myocardial perfusion imaging.
MedLine Citation:
PMID:  16750778     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Transient ischemic dilation (TID) has been established as an important independent marker of severe and extensive coronary artery disease (CAD) in myocardial perfusion imaging (MPI). The accuracy of the TID index is dependent on a well-determined threshold (normal limits) between normal and abnormal values for each study protocol. To date, the effects of neither gender nor attenuation correction (AC) on TID normal limits have been established. Thus, the objectives of this study were to determine if AC processing changes the normal value of the TID index and if there were gender-related differences in the TID index of normal patients who had undergone rest/exercise-stress technetium-99m sestamibi MPI. METHODS AND RESULTS: Seventy-five patients (33 women, 42 men; mean age, 57.7 +/- 11.7 y and 55.9 +/- 10.0 y, respectively) with less than a 5% likelihood of CAD, who had undergone low-dose rest/high-dose exercise-stress Tc-99m sestamibi MPI, were studied. All studies were acquired using simultaneous emission/transmission scans and were corrected for attenuation, scatter, and resolution effects using the ExSPECT II method. Both the AC and non-AC studies were analyzed using the Emory Cardiac Toolbox (ECTb; Syntermed, Inc, Atlanta, Ga) quantitative software. The TID index was calculated automatically as the ratio of stress mean left ventricular volumes to rest mean left ventricular volumes by ECTb. Patients were grouped by gender and the TID indices from AC and non-AC studies were compared. Linear regressions of the TID index and body mass index were analyzed to exclude differences in body size between male and female patients as a confounding factor in gender-related differences in TID. The TID index upper normal limits were calculated as the mean value plus 2 standard deviations (SDs). AC processing did not change the TID index significantly whether the genders were combined or separated (AC TID = 0.97 +/- 0.14 vs non-AC TID = 0.98 +/- 0.12 for all patients). Female patients showed higher mean TID indices than male patients in both AC (1.01 +/- 0.15 vs 0.95 +/- 0.12) and non-AC studies (1.00 +/- 0.15 vs. 0.97 +/- 0.10), but this difference was statistically significant only in AC studies (p = .03). TID indices remained constant across the range of body mass index studied. The TID index upper normal limit was 1.31 for female and 1.18 for male patients. CONCLUSION: TID normal values for rest/exercise-stress Tc-99m sestamibi MPI are gender-dependent and not affected by AC processing. Thus, diagnosticians should take into account these gender-related differences, as compared with the traditional value generated from mostly male populations, to ensure both men and women have the same overall accuracy of using the TID index in the diagnosis and prognosis of CAD.
Abel Rivero; Cesar Santana; Russell D Folks; Fabio Esteves; Liudmila Verdes; Shorena Esiashvili; Gabriel B Grossman; Raghuveer K Halkar; Timothy M Bateman; Ernest V Garcia
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology     Volume:  13     ISSN:  1071-3581     ISO Abbreviation:  J Nucl Cardiol     Publication Date:    2006 May-Jun
Date Detail:
Created Date:  2006-06-05     Completed Date:  2007-01-16     Revised Date:  2007-12-03    
Medline Journal Info:
Nlm Unique ID:  9423534     Medline TA:  J Nucl Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  338-44     Citation Subset:  IM    
Emory University School of Medicine, Atlanta, GA 30322, USA.
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MeSH Terms
Body Mass Index
Image Processing, Computer-Assisted
Ischemia* / pathology
Middle Aged
Models, Statistical
Myocardium / pathology*
Perfusion / methods*
Radiopharmaceuticals / diagnostic use
Sex Factors
Technetium Tc 99m Sestamibi / diagnostic use
Tomography, Emission-Computed, Single-Photon / methods*
Tomography, X-Ray Computed
Grant Support
Reg. No./Substance:
0/Radiopharmaceuticals; 109581-73-9/Technetium Tc 99m Sestamibi
Comment In:
J Nucl Cardiol. 2006 Nov;13(6):880; author reply 880-1   [PMID:  17174820 ]

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