Elsevier

Journal of Nuclear Cardiology

Volume 11, Issue 3, May–June 2004, Pages 263-272
Journal of Nuclear Cardiology

Original article
Quantitative Tc-99m sestamibi attenuation-corrected SPECT: development and multicenter trial validation of myocardial perfusion stress gender-independent normal database in an obese population

https://doi.org/10.1016/j.nuclcard.2004.02.007Get rights and content

Abstract

Background

A gender-independent stress normal database and criteria for abnormality for attenuation-corrected rest-stress technetium 99m sestamibi same-day myocardial perfusion imaging were developed by evaluation of 112 patients, validated against an obese population of 95 patients from four different clinical sites, and compared with conventional gender-matched database quantification of non–attenuation-corrected studies.

Methods and results

These 95 validation patients (63 men) were used for prospective quantitative evaluation (mean weight, 213 ± 57 lb; mean body mass index, 32 ± 9 kg/m2). This group included 21 patients (12 men) with a lower than 5% likelihood of coronary artery disease (mean weight, 226 ± 72 lb; mean body mass index, 34 ± 13 kg/m2) and 74 who underwent cardiac catheterization within 2 months (35 with normal coronaries or coronary lesions <70%). These studies were processed twice, once by use of conventional reconstruction and gender-specific database quantification and a second time by use of attenuation correction and a single gender-independent attenuation-corrected normal database. The attenuation-corrected normal database and criteria for abnormality were developed by evaluation of 48 and 78 patients, respectively. No statistically significant differences were found when comparing attenuation-corrected perfusion distributions of normal men and women, whereas significant differences were found in the same uncorrected studies. Compared with quantitative analysis of the uncorrected studies, quantitative analysis of the attenuation-corrected studies by use of a gender-independent normal database demonstrated a significant improvement in normalcy rate (90% vs 52%, P = .006) and specificity (57% vs 29%, P = .015) in this obese population at no significant loss in sensitivity (90% vs 97%, P = not significant).

Conclusion

Attenuation-corrected studies can be quantified with a single gender-independent normal database and a single criterion for abnormality without loss of sensitivity and with significantly better specificity and normalcy rate.

Section snippets

Population

Two hundred seven patients comprised the study population. These patients underwent ECG-gated 1-day rest-stress technetium 99m sestamibi simultaneous transmission/emission attenuation correction (VantagePro/ExSPECT II; Philips Laboratories, Milpitas, Calif) SPECT myocardial perfusion studies. The studies were obtained from four institutions: Cardiovascular Consultants–Mid America Heart Institute (Kansas City, Mo), Hartford Hospital (Hartford, Conn), Rhode Island Hospital (Providence, RI), and

Distribution of normal limits

The comparisons of the uncorrected and AC normal perfusion distributions in men and women by use of Tc-99m sestamibi stress are shown in Figure 1. The uncorrected normal distributions yielded 7 out of 20 segments that showed significant differences between genders at a P < .001 level. The AC normal distributions showed no significant differences between genders at a P < .001 level (Figure 2).

Determination of criteria for stress abnormality

The determined criteria for stress abnormality expressed in terms of SDs below the mean normal limit

Discussion

This study was performed to develop and validate the stress normal limits and criteria for abnormality for quantitative same-day rest-stress Tc-99m sestamibi AC SPECT studies by use of a gender-independent normal database. Validation was performed with coronary arteriography used as a gold standard to determine the accuracy of this AC quantitative analysis for the detection and localization of CAD in a multicenter prospective obese population. These results were compared with results from the

Acknowledgements

Some of the authors (E.V.G., T.M.B., R.D.F., S.J.C., J.R.G., and J.A.C.) receive royalties from the sale of the application software (ExSPECT II) related to the research described in this article. In addition, some of the authors (E.V.G. and R.D.F.) receive royalties from the sale of the Emory Cardiac Toolbox used for quantification comparisons in this study. The terms of this arrangement have been reviewed and approved by Emory University in accordance with its conflict-of-interest policy.

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