Research ArticleCLINICAL INVESTIGATIONS

Motion-Frozen Myocardial Perfusion SPECT Improves Detection of Coronary Artery Disease in Obese Patients

Yasuyuki Suzuki, Piotr J. Slomka, Arik Wolak, Muneo Ohba, Shoji Suzuki, Ling De Yang, Guido Germano and Daniel S. Berman
Journal of Nuclear Medicine July 2008, 49 (7) 1075-1079; DOI: https://doi.org/10.2967/jnumed.108.050997

Article Figures & Data

Figures

  • FIGURE 1. 
    FIGURE 1. 

    Segmental comparison of sex-specific standard and MF normal limits for male and female patients. Asterisks in polar-map segments denote significant differences between standard and MF databases (P < 0.05).

  • FIGURE 2. 
    FIGURE 2. 

    ROC curves for detection of ≥50% stenosis (A) and ≥70% stenosis (B) by measures of S-TPD and MF-TPD in obese patients (n = 90).

  • FIGURE 3. 
    FIGURE 3. 

    Sensitivity, specificity, and accuracy for detection of CAD with ≥50% stenosis criterion (A) and ≥70% stenosis criterion (B) by S-TPD and MF-TPD in obese group. NS = not significant.

  • FIGURE 4. 
    FIGURE 4. 

    An example of false-positive summed perfusion results corrected by MF analysis in 68-y-old asymptomatic woman with hypertension, hypercholesterolemia, and ST depression during adenosine stress. Subsequent coronary angiogram showed no significant stenosis. Her left ventricular ejection fraction at stress was 76%. Selected stress images are shown in distal (apical) short axis (SA), mid-horizontal long axis (HLA), and mid-vertical long axis (VLA). MF perfusion images appear larger than summed images because they are warped to ED position. MF images show brighter anterior and lateral wall from base to midsegments than standard perfusion images. On VLA and SA, MF images show brighter distal anterior wall than standard summed image, whereas MF images show count reduction in apex likely due to anatomic apical thinning. Quantitative analysis (right) shows insignificant apical thinning on MF MPS (TPD 3%) and significant defect in same location on standard MPS data (TPD 8%).

Tables

  • TABLE 1

    Characteristics of Obese Patients Comprising Study Population

    ParameterValue (n = 90)
    Mean age ± SD (y)63 ± 12
    Sex (female)27 (30%)
    Mean BMI ± SD (kg/m2)34.3 ± 3.6
    Hypertension67 (74%)
    Diabetes36 (40%)
    Hypercholesterolemia45 (50%)
    Symptoms
     Asymptomatic15 (17%)
     Nonanginal chest pain8 (9%)
     Atypical angina36 (40%)
     Typical angina14 (16%)
     Shortness of breath9 (10%)
    Exercise stress45 (50%)
  • TABLE 2

    Angiographic Characteristics

    ParameterNo. of cases (n = 90)
    ≥70% stenosis59 (66%)
    ≥50% stenosis63 (70%)
    Single-vessel disease*29 (32%)
    Double-vessel disease*16 (18%)
    Triple-vessel disease*14 (16%)

    • ↵* Based on ≥70% stenosis criterion.

  • TABLE 3

    Concordance and Discordance Between S-TPD and MF-TPD Results

    Catheterization resultConcordant: both TNDiscordant: FP S-TPDConcordant: both FPDiscordant: FP MF-TPDConcordant: both TPDiscordant: FN S-TPDConcordant: both FNDiscordant: FN MF-TPD
    CAD ≥50% (−) (n = 27)16650
    CAD ≥70% (−) (n = 31)17770
    CAD ≥50% (+) (n = 63)57141
    CAD ≥70% (+) (n = 59)55130

    • TN = true-negative; FP = false-positive; TP = true-positive; FN = false-negative.

  • TABLE 4

    Characteristics of Patients Who Had False-Positive S-TPD Corrected by MF-TPD for Detection of ≥70% Stenosis

    Patient no.Age (y)SexBMIStress ejection fraction (%)S-TPD (%)MF-TPD (%)
    162Male336473
    288Male353363
    3*68Female337683
    466Female406063
    556Male364164
    660Male3459104
    776Male325674

    • ↵* True-positive for S-TPD for detection of ≥50% stenosis.

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