Improved Quantification and Normal Limits for Myocardial Perfusion Stress–Rest Change

Journal of Nuclear Medicine

Daniel S. Berman¹  Sean Hayes¹  Paul Kavanagh¹  Piotr J. Slomka¹  Mathews Fish¹  Mithun Prasad¹  Guido Germano¹  James Gerlach¹ 

关键词: SPECT;    normal limits;    myocardial perfusion stress–rest change;    quantification;   

DOI  :  10.2967/jnumed.109.067736

学科分类：医学（综合）

来源: Society of Nuclear Medicine

【 摘 要 】

We aimed to improve the quantification of myocardial perfusion stress–rest changes in myocardial perfusion SPECT (MPS) studies for the optimal automatic detection of ischemia and coronary artery disease (CAD). Methods: Rest–stress 99mTc MPS studies (997 cases; 651 consecutive cases with correlating angiography and 346 cases with less than 5% likelihood (low likelihood [LLK]) of CAD) were analyzed. Normal limits for stress–rest changes were derived from additional LLK patients (40 women, 40 men). We computed the global stress–rest change (C-SR) by integrating direct stress–rest changes for each polar map pixel. Additionally, stress–rest change and total perfusion deficit (TPD) at stress were combined in 1 variable (C-TPD) for the optimal detection of CAD. Results: The area under the receiver-operating-characteristic curve (AUC) for C-SR (0.92) was larger than that for stress TPD–rest TPD (0.88) for the identification of stenosis of 70% or more (P < 0.0001). AUC (0.94) and sensitivity (90%) for C-TPD were higher than those for stress TPD (0.91 and 83%, respectively) (P < 0.0001), whereas specificity remained the same (81%). Conclusion: C-SR and C-TPD provide higher diagnostic performance than difference between stress and rest TPD or stress hypoperfusion analysis.

【 授权许可】

Unknown