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Automatic Detection and Size Quantification of Infarcts by Myocardial Perfusion SPECT: Clinical Validation by Delayed-Enhancement MRI

¹ Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, California
² Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California

We aimed to validate the accuracy of a new automated myocardial perfusion SPECT quantification based on normal limits for detection and sizing of infarcts, using delayed-enhancement MRI (DE-MRI) as a gold standard. Methods: Eighty-two immediate ²⁰¹Tl rest scans and 26 ²⁰¹Tl delayed redistribution scans were compared with resting DE-MRI scans acquired within 24 h of SPECT acquisition. The immediate ²⁰¹Tl scans were considered for validation of infarct detection and the delayed ²⁰¹Tl scans were considered for infarct sizing. A simplified quantification scheme was used in which defect extent (EXT) and total perfusion deficit (TPD) parameters were derived automatically from SPECT images by comparison with sex-matched normal limits and applying a 3.0 average deviation criterion. The total extent of hyperenhancement expressed as the percentage of the left ventricle was derived from DE-MRI images by visual definition of myocardial contours and defects. DE-MRI and SPECT images were fused in 3 dimensions for visual comparison. Phantom data were also quantified using the same EXT and TPD measures for defects ranging from 5% to 70% of the myocardium. Results: The area under the receiver-operator-characteristic curve for the detection of infarct on immediate rest scans was 0.91 ± 0.03 for EXT and 0.90 ± 0.03 for TPD (P = not significant). The sensitivity and specificity for the detection of infarct by EXT on immediate ²⁰¹Tl rest scan were 87% and 91%, respectively, with the optimal defect size threshold of 4%. Six of 7 cases with DE-MRI defects < 5% were detected by SPECT. Infarct sizes obtained from DE-MRI correlated well with EXT (slope = 0.94, offset = 3.8%; r = 0.84) and TPD (slope = 0.75, offset = 4.2%; r = 0.85) obtained from delayed SPECT ²⁰¹Tl scans. Excellent correlation was observed between the SPECT quantification and the physical defect size for the phantom data. The actual size of the defect was better estimated by EXT (slope = 1.00, offset 1.33%; r = 0.99) than by TPD (slope = 0.79, offset = 1.9%; r = 0.99). Conclusion: Automated quantification of the EXT on myocardial perfusion SPECT images can reliably detect infarcts and measure infarct sizes.

Key Words: SPECT quantification • myocardial perfusion • multimodality • infarct • delayed-enhancement MRI

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