Document Detail

Quantitative assessment of myocardial perfusion abnormality on SPECT myocardial perfusion imaging is more reproducible than expert visual analysis.
MedLine Citation:
PMID:  19152128     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Current guidelines of Food and Drug Administration for the evaluation of SPECT myocardial perfusion imaging (MPI) in clinical trials recommend independent visual interpretation by multiple experts. Few studies have addressed whether quantitative SPECT MPI assessment would be more reproducible for this application.
METHODS AND RESULTS: We studied 31 patients (age 68 +/- 13, 25 male) with abnormal stress MPI who underwent repeat exercise (n = 11) or adenosine (n = 20) MPI within 9-22 months (mean 14.9 +/- 3.8 months) and had no interval revascularization or myocardial infarction and no change in symptoms, stress type, rest or stress ECG, or clinical response to stress on the second study. Visual interpretation per FDA Guidance used 17-segment, 5-point scoring by two independent expert readers with overread of discordance by a third expert, and percent myocardium abnormal was derived from normalized summed scores. The quantitative magnitude of perfusion abnormality was assessed by the total perfusion deficit (TPD), expressing stress, rest, and ischemic perfusion abnormality. High linear correlations were observed between visual and quantitative size of stress, rest, and ischemic defects (R = 0.94, 0.92, 0.84). Correlations of two tests were higher by quantitative than by visual methods for stress (R = 0.97 vs R = 0.91, P = 0.03) and rest defects (R = 0.94 vs R = 0.82, P = 0.03), respectively, and statistically similar for ischemic defects (R = 0.84 vs R = 0.70, P = ns).
CONCLUSIONS: In stable patients having serial SPECT MPI, quantification is more reproducible than visual for magnitude of perfusion abnormality, suggesting its superiority for use in randomized clinical trials and monitoring the effects of therapy in an individual patient.
Daniel S Berman; Xingping Kang; Heidi Gransar; James Gerlach; John D Friedman; Sean W Hayes; Louise E J Thomson; Rory Hachamovitch; Leslee J Shaw; Piotr J Slomka; Ling De Yang; Guido Germano
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2009-01-20
Journal Detail:
Title:  Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology     Volume:  16     ISSN:  1532-6551     ISO Abbreviation:  J Nucl Cardiol     Publication Date:    2009 Jan-Feb
Date Detail:
Created Date:  2009-01-19     Completed Date:  2009-07-09     Revised Date:  2013-04-18    
Medline Journal Info:
Nlm Unique ID:  9423534     Medline TA:  J Nucl Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  45-53     Citation Subset:  IM    
Department of Imaging (Division of Nuclear Medicine), Cedars-Sinai Heart Institute, 8700 Beverly Boulevard, Room 1258, Los Angeles, CA 90048, USA.
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MeSH Terms
Coronary Artery Disease / complications,  radionuclide imaging*
Image Enhancement / methods
Image Interpretation, Computer-Assisted / methods*
Myocardial Ischemia / complications,  radionuclide imaging*
Observer Variation
Pattern Recognition, Automated / methods*
Reproducibility of Results
Sensitivity and Specificity
Tomography, Emission-Computed, Single-Photon / methods*
Ventricular Dysfunction, Left / complications,  radionuclide imaging*
Grant Support
Comment In:
J Nucl Cardiol. 2009 Jan-Feb;16(1):6-9   [PMID:  19152123 ]

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