Elsevier

Journal of Nuclear Cardiology

Volume 17, Issue 6, December 2010, Pages 1050-1057
Journal of Nuclear Cardiology

Original Article
Automatic and visual reproducibility of perfusion and function measures for myocardial perfusion SPECT

https://doi.org/10.1007/s12350-010-9297-0Get rights and content

Abstract

Background

We define the repeatability coefficients (RC) of key quantitative and visual perfusion and function parameters that can be derived by the QGS/QPS automated software and by expert visual observer from gated myocardial perfusion SPECT (MPS) scans.

Methods

Standard QGS/QPS algorithms have been applied to derive quantitative perfusion and function parameters in 200 99mTc-tetrofosmin rest/stress MPS scans, obtained in 100 consecutive patients who underwent 2 separate gated rest/stress scans on the same camera. Variables included stress, rest, and ischemic total perfusion deficit (TPD), ejection fraction, motion, and thickening. Visual perfusion/motion scores were derived by an expert reader using randomized scan order and normalized to % myocardium.

Results

Quantitative and visual parameters were highly reproducible with smaller RC for some quantitative measures as compared to visual measures (P < .0001). RC for quantitative measures were 3.3% for stress TPD, 1.8% for rest TPD, and 3.2% for ischemic TPD and for visual scoring 4.8% for stress, 3.8% for rest, and 4.3% for ischemic (P ≤ .002). The results in each vessel territory showed that in the right coronary artery (RCA) territory the quantitative approach had improved reproducibility as compared to visual reading. Visual thickening scoring was more reproducible than motion scoring (P < .0001).

Conclusions

This study demonstrates that standard perfusion and function parameters derived from MPS by visual or quantitative analysis are highly reproducible with some advantages to the quantitative approach.

Introduction

Visual and quantitative perfusion and function assessments of myocardial perfusion SPECT (MPS) are important in detection and evaluation of coronary artery disease (CAD).1 Reproducibility analysis for these parameters is essential in understanding the significance of changes seen in serial studies. Most previous studies have reported the inter-/intra-observer agreement for one MPS test or the reproducibility of measures for retrospective studies.2, 3, 4, 5, 6 A recent study has reported the reproducibility of visual perfusion derived by current automated software for test–retest MPS studies obtained with the same radiopharmaceutical injection.7 The aim of this study is to comprehensively evaluate the reproducibility of both visual and automated quantifications of perfusion and function parameters from MPS stress and rest scans that were repeated in the same scanning session.

Section snippets

Patients

One hundred studies with repeated stress and rest MPS acquisitions were obtained from July 2007 to March 2008 at Nuclear Cardiology Diagnostic Imaging Laboratory, University of Ottawa Heart Institute, Ottawa, Canada, to evaluate the reproducibility of MPS measures.

The population age was 56 ± 11 years and included 20 studies with prior myocardial infarction, 25 cases with percutaneous coronary intervention, and 8 with coronary artery bypass graft. The clinical characteristics for all the

Results

160 of 800 contours generated from QPS/QGS (gated image: 21%; ungated image: 19%) needed adjustment, as determined by experienced technologist. Most of the adjustments were subtle, only rearranging the valve-plane positioning. Only 13 cases were adjusted by giving a corrected initial ellipsoid. Eleven cases with incorrect ellipsoid determination had high shape quality control flag value (≥4.11).9

Discussion

This is the first study, which comprehensively evaluates and compares intra-observer visual and quantitative reproducibility of wide range of function and perfusion parameters in MPS studies obtained with the same injection of radiopharmaceutical. We included most of visual and quantitative parameters, which have been used in clinical practice including TPD, WM, and thickening. It should be noted that in this study an experienced attending physician was reading blinded scans in two consecutive

Conclusion

This study demonstrates that standard perfusion and function parameters derived by expert visual or quantitative analysis are highly reproducible with significant advantages for the quantitative approach especially for the stress and ischemic perfusion variables.

Acknowledgments

This research was supported in part by Grant R0HL089765-01 from the National Heart, Lung, and Blood Institute/National Institutes of Health (NHLBI/NIH) (PI: Piotr Slomka). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NHLBI. We would like to thank James Gerlach and Mark Hyun for adjusting contours.

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