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Prognostic Implications of Combined Prone and Supine Acquisitions in Patients with Equivocal or Abnormal Supine Myocardial Perfusion SPECT

¹ Department of Imaging, Division of Nuclear Medicine, Cedars-Sinai Medical Center, Los Angeles, California
² Department of Medicine, Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California
³ Department of Medicine, Division of Cardiology, University of Southern California, School of Medicine, Los Angeles, California
⁴ Department of Medicine, University of California Los Angeles, School of Medicine, Los Angeles, California

View larger version (53K): [in a new window]   FIGURE 1. Postexercise 99mTc-sestamibi MPS images of 83-y-old asymptomatic man. Perfusion defect is noted in inferior and inferoapical walls in poststress supine images. Poststress prone images are normal, demonstrating that apparent perfusion defect is secondary to soft-tissue attenuation. Normal wall motion was noted on gated SPECT.

View larger version (15K): [in a new window]   FIGURE 2. Injection and acquisition protocol for prone and supine MPS study. *15 min for exercise, 1 h for no walk adenosine (adapted and reprinted with permission of (24)).

View larger version (21K): [in a new window]   FIGURE 3. Risk-adjusted hard event rates in patients undergoing supine-only or prone and supine acquisition, according to MPS interpretation. P < 0.0001 across scan categories; P > 0.05 for comparisons between supine-only or prone and supine. Mod-sev = moderately to severely abnormal.

View larger version (22K): [in a new window]   FIGURE 4. Risk-adjusted total event rates in patients undergoing supine-only or prone and supine acquisition, according to MPS interpretation. P < 0.0001 across scan categories; P > 0.05 for comparisons between supine-only or prone and supine. Mod-sev = moderately to severely abnormal.