PT - JOURNAL ARTICLE AU - Mithun Prasad AU - Piotr J. Slomka AU - Mathews Fish AU - Paul Kavanagh AU - James Gerlach AU - Sean Hayes AU - Daniel S. Berman AU - Guido Germano TI - Improved Quantification and Normal Limits for Myocardial Perfusion Stress–Rest Change AID - 10.2967/jnumed.109.067736 DP - 2010 Feb 01 TA - Journal of Nuclear Medicine PG - 204--209 VI - 51 IP - 2 4099 - http://jnm.snmjournals.org/content/51/2/204.short 4100 - http://jnm.snmjournals.org/content/51/2/204.full SO - J Nucl Med2010 Feb 01; 51 AB - 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.