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The accuracy of 1-day dual-isotope myocardial SPECT in a population with high prevalence of coronary artery disease

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Abstract

Background: In order to evaluate the diagnostic efficacy of the 1-day separate acquisition dual-isotope single-photon emission computed tomography (SPECT) protocol, using 201Tl for the rest and 99mTc-tetrofosmin for the stress images, a consecutive series of patients with suspected or known coronary artery disease (CAD) was studied that also underwent coronary angiography. Methods: The results of myocardial SPECT, using a semi-quantitative visual analysis, were acquired in 123 patients and compared with the results of coronary angiography. Sensitivity and specificity were calculated, using thresholds of ≥50 and ≥70% stenosis. As an alternative for specificity, the normalcy rate was determined in a separate group of 87 patients with a <5% pre-test likelihood of CAD. Results: The prevalence of CAD using ≥50 and ≥70% stenosis was 88 and 78%, respectively. The sensitivity for detection of patients with ≥50 and ≥70% stenosis was 94 and 97%, respectively while specificity was 62 and 59%, respectively. The high rate of false positive perfusion defects resulting in a low specificity could be explained by specific clinical issues. However, the routine assessment with additional clinical and electrocardiographic data resulted in a correct interpretation of most of the false positive perfusion defects. The positive predictive value was 92 and 85% and the negative predictive value 46 and 77%, using thresholds of ≥50 and ≥70% stenosis, respectively. The normalcy rate was 91%. Conclusion: The one-day separate acquisition rest 201Tl/stress 99mTc-tetrofosmin SPECT protocol is an efficient procedure for myocardial perfusion scintigraphy with high sensitivity for detection of CAD. Specific clinical issues caused a low value for specificity. Therefore, clinical information and knowledge of the electrocardiogram is essential for a correct interpretation of SPECT images.

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Authors and Affiliations

  1. Department of Cardiology, University Hospital, Leiden, The Netherlands

    Reginald G.E.J. Groutars, Carl A.P.L. Ascoop, Norbert M. van Hemel & Ernst E. van der Wall

  2. Department of Nuclear Medicine, University Hospital, Leiden, The Netherlands

    J. Fred Verzijlbergen & Monique M.C. Tiel-van Buul

  3. Department of Medical Statistics, University Hospital, Leiden, The Netherlands

    Aeilco H. Zwinderman

Authors
  1. Reginald G.E.J. Groutars
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  2. J. Fred Verzijlbergen
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  3. Monique M.C. Tiel-van Buul
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  4. Aeilco H. Zwinderman
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  5. Carl A.P.L. Ascoop
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  6. Norbert M. van Hemel
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  7. Ernst E. van der Wall
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Groutars, R.G., Verzijlbergen, J.F., Tiel-van Buul, M.M. et al. The accuracy of 1-day dual-isotope myocardial SPECT in a population with high prevalence of coronary artery disease. Int J Cardiovasc Imaging 19, 229–238 (2003). https://doi.org/10.1023/A:1023637804898

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  • DOI: https://doi.org/10.1023/A:1023637804898

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