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Feasibility and Diagnostic Accuracy of a Gated SPECT Early-Imaging Protocol: A Multicenter Study of the Myoview Imaging Optimization Group

CNR Institute of Clinical Physiology, Pisa, Italy

View larger version (25K): [in this window] [in a new window]   FIGURE 1.  (A) Linear regression analysis showed good relationship between T1 and T2 SDS (y = 0.689x + 799; r = 0.69; SEE = 0.06; P < 0.0001). (B) Bland–Altman analysis showed good agreement between T1 and T2 SDS. (C) ROC curve analysis identified cutoffs of 2.5 for T1 and 1.5 for T2 SDS as best separating patients with from those without coronary artery disease. (D) With these thresholds, global diagnostic accuracy was identical between T1 and T2 (0.80 vs. 0.81, P = NS).

View larger version (33K): [in this window] [in a new window]   FIGURE 2.  (A and B) In patients with T1 – T2 SDS of more than 2, linear regression analysis (A) showed good correlation between T1 and T2 SDS (y = 0.89x +2.98; r = 0.67; SEE = 0.1; P < 0.0001), whereas Bland–Altman method (B) showed shift in mean value of difference of +2.67 ± 2.73. (C) ROC curve analysis identified cutoffs of 3.0 for T1 and 2.0 for T2 SDS as best separating patients with and without coronary artery disease. (D) With these thresholds, T1 resulted in global diagnostic accuracy significantly higher than that of T2 imaging (0.79 vs. 0.70, P < 0.001).

View larger version (70K): [in this window] [in a new window]   FIGURE 3.  Perfusion bull's eyes (left) and relative quantitative perfusion SPECT scores (right) in patient with previous myocardial infarction and double-vessel disease. (Top) Early imaging identified fixed perfusion defect of inferior wall and reversible defect of anterior and anteroseptal walls, resulting in SDS of 10. (Bottom) Standard delayed imaging failed to identify reversible defect in territory of left anterior descending coronary artery, resulting in SDS of 1. Therefore, 2 different clinical messages were obtained from same patient: previous inferior myocardial infarction plus anterior myocardial ischemia using early imaging and previous inferior infarction without ischemia using standard delayed scans.

View larger version (36K): [in this window] [in a new window]   FIGURE 4.  (A and C) Linear regression analysis (A) showed good correlation between T1 and T2 poststress EFs (y = 0.968x + 1.428; r = 0.95; SEE = 0.03; P < 0.0001), whereas Bland–Altman method (C) showed good agreement between the 2 sets of measures. (B) Similarly, linear regression analysis showed good correlation between T1 and T2 resting EFs (y = 0.961x + 1.641; r = 0.94; SEE = 0.03; P < 0.0001). (D) Bland–Altman method showed shift in mean value of difference of +0.51 ± 4.13.