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

¹ Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California; ² AIM Program/Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California; ³ David Geffen School of Medicine, UCLA, Los Angeles, California; and ⁴ Sacred Heart Medical Center, Eugene, Oregon

Correspondence: For correspondence or reprints contact: Piotr Slomka, 8700 Beverly Blvd., Ste. A047, Los Angeles, CA 90048. E-mail: SlomkaP{at}cshs.org

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.

Key Words: SPECT • normal limits • myocardial perfusion stress–rest change • quantification

COPYRIGHT © 2010 by the Society of Nuclear Medicine, Inc.

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JNM 2010 51: 11A-12A. [Full Text]