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Gated ^99mTc-Tetrofosmin SPECT for Discriminating Infarct from Artifact in Fixed Myocardial Perfusion Defects

¹ Cardiovascular Center, Nuclear Cardiology Section, University Hospital Zurich, Zurich, Switzerland
² Division of Echocardiography, University Hospital Zurich, Zurich, Switzerland

View larger version (70K): [in a new window]   FIGURE 1. Polar map view of a normalized rest perfusion scan and the corresponding thickening assessed by gated SPECT. (A) Example of a patient with fixed inferoseptal perfusion defect but normal thickening in all segments. (B) Example of a patient with fixed inferolateral perfusion defect with congruent decreased wall thickening.

View larger version (18K): [in a new window]   FIGURE 2. (A) Receiver operator characteristic curve for segmental systolic wall thickening as obtained by gated SPECT versus the gold standard echocardiography. Area under the curve = 0.895. For a cutoff value of 33%, sensitivity and specificity are 79% and 99%, respectively. (B) Receiver operator characteristic curve for segmental systolic wall motion (mm) as obtained by gated SPECT versus the gold standard echocardiography. Area under the curve = 0.710. For a cutoff value of 40%, sensitivity and specificity are 50% and 90%, respectively.

View larger version (18K): [in a new window]   FIGURE 3. Schematic overview of patients with fixed defect or normal perfusion grouped according to the wall thickening finding in gated SPECT. FN = false-negative; FP = false-positive; TN = true-negative; TP = true-positive.

View larger version (17K): [in a new window]   FIGURE 4. 2 test comparing pathologic thickening vs. electrocardiographic and historical evidence of MI in patients with fixed perfusion defects. NPV = negative predictive value; PPV = positive predictive value; Sens = sensitivity; Spec = specificity. Overall agreement was 83%. The P value for the 2 test was <0.005.