Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2009 Jan-Feb;16(1):45-53.
doi: 10.1007/s12350-008-9018-0. Epub 2009 Jan 20.

Quantitative assessment of myocardial perfusion abnormality on SPECT myocardial perfusion imaging is more reproducible than expert visual analysis

Daniel S Berman  1 , Xingping Kang, Heidi Gransar, James Gerlach, John D Friedman, Sean W Hayes, Louise E J Thomson, Rory Hachamovitch, Leslee J Shaw, Piotr J Slomka, Ling De Yang, Guido Germano
Affiliations
Comparative Study

Quantitative assessment of myocardial perfusion abnormality on SPECT myocardial perfusion imaging is more reproducible than expert visual analysis

Daniel S Berman et al. J Nucl Cardiol. 2009 Jan-Feb.

Abstract

Background: Current guidelines of Food and Drug Administration for the evaluation of SPECT myocardial perfusion imaging (MPI) in clinical trials recommend independent visual interpretation by multiple experts. Few studies have addressed whether quantitative SPECT MPI assessment would be more reproducible for this application.

Methods and results: We studied 31 patients (age 68 +/- 13, 25 male) with abnormal stress MPI who underwent repeat exercise (n = 11) or adenosine (n = 20) MPI within 9-22 months (mean 14.9 +/- 3.8 months) and had no interval revascularization or myocardial infarction and no change in symptoms, stress type, rest or stress ECG, or clinical response to stress on the second study. Visual interpretation per FDA Guidance used 17-segment, 5-point scoring by two independent expert readers with overread of discordance by a third expert, and percent myocardium abnormal was derived from normalized summed scores. The quantitative magnitude of perfusion abnormality was assessed by the total perfusion deficit (TPD), expressing stress, rest, and ischemic perfusion abnormality. High linear correlations were observed between visual and quantitative size of stress, rest, and ischemic defects (R = 0.94, 0.92, 0.84). Correlations of two tests were higher by quantitative than by visual methods for stress (R = 0.97 vs R = 0.91, P = 0.03) and rest defects (R = 0.94 vs R = 0.82, P = 0.03), respectively, and statistically similar for ischemic defects (R = 0.84 vs R = 0.70, P = ns).

Conclusions: In stable patients having serial SPECT MPI, quantification is more reproducible than visual for magnitude of perfusion abnormality, suggesting its superiority for use in randomized clinical trials and monitoring the effects of therapy in an individual patient.

PubMed Disclaimer

Figures

Figure 1
Figure 1
A figure illustrating the concept of total perfusion deficit (TPD). A circumferential profile for one short axis slice is shown with corresponding normal limits. The areas below the normal limit curve but above the circumferential profile curve for a given slice define perfusion deficit in a given slice. These areas are computed for all circumferential profiles in the myocardium and summed forming TPD.
Figure 2
Figure 2
Correlation of stress perfusion defects by visual (left) and quantitative (right) analyses between study 1 and study 2. P = 0.03 for the comparison between visual and quantification. % myo = percent of myocardium abnormal; TPD = total perfusion deficit.
Figure 3
Figure 3
Correlation of rest perfusion defects by visual (left) and quantitative (right) analyses between study 1 and study 2. P = 0.03 for the comparison between visual and quantification. Abbreviations as in Figure 2.
Figure 4
Figure 4
Correlation of ischemic perfusion defects by visual (left) and quantitative (right) analyses between study 1 and study 2. P > 0.05 for the comparison between visual and quantification. Abbreviations as in Figure 2.
Figure 5
Figure 5
Correlation (left) and differences (right) of stress perfusion defects by visual and quantitative analyses on study 1. Quant = quantitative; other abbreviations as in Figure 2.
Figure 6
Figure 6
Correlation (left) and differences (right) of rest perfusion defects by visual and quantitative analyses on study 1. Abbreviations as in Figure 5.
Figure 7
Figure 7
Correlation (left) and differences (right) of ischemic perfusion defects by visual and quantitative analyses on study 1. Abbreviations as in Figure 5.
See this image and copyright information in PMC

Comment in

References

    1. Mahmarian JJ, Shaw LJ, Filipchuk NG, et al. A multinational study to establish the value of early adenosine technetium-99m sestamibi myocardial perfusion imaging in identifying a low-risk group for early hospital discharge after acute myocardial infarction. J Am Coll Cardiol. 2006;48:2448–57. - PubMed
    1. Shaw LJ, Berman DS, Maron DJ, et al. Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden: Results from the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial nuclear substudy. Circulation. 2008;117:1283–91. - PubMed
    1. Dangas G, Stone GW, Weinberg MD, et al. Contemporary outcomes of rescue percutaneous coronary intervention for acute myocardial infarction: Comparison with primary angioplasty and the role of distal protection devices (EMERALD trial) Am Heart J. 2008;155:1090–6. - PubMed
    1. Schwartz RG, Pearson TA, Kalaria VG, et al. Prospective serial evaluation of myocardial perfusion and lipids during the first six months of pravastatin therapy: Coronary artery disease regression single photon emission computed tomography monitoring trial. J Am Coll Cardiol. 2003;42:600–10. - PubMed
    1. U.S. Department of Health and Human Services, FDA. Guidance for industry developing medical imaging drug and biological products. Part 3: Design, analysis, and interpretation of clinical studies. 2004 Jun; http://www.fda.gov/cber/gdlns/medimagestud.htm.

Publication types

MeSH terms