Feasibility and diagnostic accuracy of a gated SPECT early-imaging protocol: A multicenter study of the myoview imaging optimization group

Assuero Giorgetti, Massimiliano Rossi, Mario Stanislao, Guido Valle, Pietro Bertolaccini, Alberto Maneschi, Raffaele Giubbini, Maria Luisa De Rimini, Marco Mazzanti, Mario Cappagli, Elisa Milan, Duccio Volterrani, Paolo Marzullo

Research output: Contribution to journalArticle

Abstract

The aim of this study was to investigate whether early (time 1, or T1) myocardial tetrofosmin imaging is feasible and as accurate in detecting coronary artery disease as is standard delayed (time 2, or T2) imaging. Methods: One hundred twenty patients (100 men and 20 women; mean age ± SD, 61 ± 10 y) with anginal symptoms underwent tetrofosmin gated SPECT. Stress/rest T1 imaging was performed at 15 min and T2 at 45 min after injection. Image quality was visually evaluated using a 4-point scale (from 0 = poor to 3 = optimal). Myocardial perfusion analysis was performed on a 20-segment model using quantitative perfusion SPECT software, and reversible ischemia was scored as a summed difference score (SDS). Coronary angiography was performed within 1 mo on all patients, and stenosis of more than 50% of the diameter was considered significant. Results: Overall, quality was scored as optimal or good for 94% of T1 images and 95% of T2 images (P = not statistically significant). Heart, lung, liver, and subdiaphragmatic counts did not differ for stress and rest T1 and T2 imaging. A good linear relationship was seen between T1 and T2 SDS (r = 0.69; P <0.0001), and Bland-Altman analysis showed good agreement between the 2 conditions. In terms of global diagnostic accuracy, areas under the receiver-operating-characteristic curve were comparable between T1 and T2 (0.80 vs. 0.81, P = not statistically significant). Discrepancies between T1 and T2 SDS were observed in 44% of patients (T1 - T2 SDS > 2). Linear regression analysis showed a good correlation between T1 and T2 SDS (r = 0.67; P <0.0001), whereas the Bland-Altman method showed a shift in the mean value of the difference of 12.67 ± 2.73. In patients with a T1 - T2 SDS of more than 2, areas under the receiver-operating-characteristic curves were significantly higher for T1 than for T2 images (0.79 vs. 0.70, P <0.001). Conclusion: T1 imaging is feasible and as accurate as T2 imaging in identifying coronary artery disease. However, in a discrete subset of patients, early acquisition strengthens the clinical message of defect reversibility by permitting earlier, more accurate identification of more severe myocardial ischemia.

Original languageEnglish
Pages (from-to)1670-1675
Number of pages6
JournalJournal of Nuclear Medicine
Volume48
Issue number10
DOIs
Publication statusPublished - Oct 1 2007

Keywords

  • Coronary artery disease
  • Delayed imaging
  • Early imaging
  • Gated SPECT
  • Myocardial imaging
  • Tetrofosmin

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology

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    Giorgetti, A., Rossi, M., Stanislao, M., Valle, G., Bertolaccini, P., Maneschi, A., Giubbini, R., De Rimini, M. L., Mazzanti, M., Cappagli, M., Milan, E., Volterrani, D., & Marzullo, P. (2007). Feasibility and diagnostic accuracy of a gated SPECT early-imaging protocol: A multicenter study of the myoview imaging optimization group. Journal of Nuclear Medicine, 48(10), 1670-1675. https://doi.org/10.2967/jnumed.106.039107