Loïc Djaileb1,2,3, Benjamin Dubois4, Nicolas de Leiris1,3, Julien Leenhardt1,3, Marjorie Canu1, Olivier Phan Sy3, Adrien Carabelli1,5, Bastien Boussat6, Laurent Dumas1,2, Alexis Broisat1,2, Gérald Vanzetto1,2,5, Daniel Fagret1,2,3, Catherine Ghezzi1,2, Gilles Barone-Rochette1,2,5, Laurent M Riou7,8. 1. INSERM, U1039, Radiopharmaceutiques Biocliniques, Faculté de Médecine de Grenoble, F-38700, La Tronche, France. 2. Université Grenoble-Alpes, Grenoble-Alpes, France. 3. Nuclear Medicine Department, Grenoble-Alpes University Hospital, Grenoble-Alpes, France. 4. Nuclear Medicine Department, Savoie Metropole Hospital, Chambery, France. 5. Cardiology Department, Grenoble-Alpes University Hospital, Grenoble-Alpes, France. 6. TIMC-IMAG, UMR CNRS 5525, Grenoble-Alpes, France. 7. INSERM, U1039, Radiopharmaceutiques Biocliniques, Faculté de Médecine de Grenoble, F-38700, La Tronche, France. Laurent.Riou@univ-grenoble-alpes.fr. 8. Université Grenoble-Alpes, Grenoble-Alpes, France. Laurent.Riou@univ-grenoble-alpes.fr.
Abstract
PURPOSE: To determine whether the assessment of regional wall thickening (WT) in addition to myocardial perfusion from stress supine acquisitions could compensate for the lack of prone acquisition and the corresponding decrease in the diagnostic performance of SPECT myocardial perfusion imaging (MPI) in patients with known or suspected coronary artery disease (CAD). METHODS: The study group comprised 41 patients (123 vessels) with known or suspected CAD prospectively recruited for systematic prone and supine 201Tl stress SPECT MPI. The diagnostic performance of SPECT MPI was determined for various image sets including nongated supine images (supine NG), nongated combined prone and supine images (prone and supine NG) and gated supine images, allowing WT evaluation from NG images in addition to perfusion (supine NG + WT) using invasive coronary angiography and fractional flow reserve as the gold standards. RESULTS: The rate of false positives was significantly higher among the supine NG images (20.8%) than among either the prone and supine NG or the supine NG + WT images (3.3% and 2.7%, respectively, P < 0.05 vs. supine NG). Consequently, specificity was higher for the prone and supine NG images than for the supine NG images (96.1% vs. 76.1%, P < 0.01) and was highest for the supine NG + WT images (96.8%, P not significant vs. prone and supine NG), without significant differences in sensitivity (80.0%, 86.6% and 73.3%, respectively, P not significant for all comparisons). CONCLUSION: The diagnostic performance of supine stress SPECT MPI is improved when WT assessment of ischaemic segments is used as an additional diagnostic criterion to values not significantly different from those with combined prone and supine acquisitions.
PURPOSE: To determine whether the assessment of regional wall thickening (WT) in addition to myocardial perfusion from stress supine acquisitions could compensate for the lack of prone acquisition and the corresponding decrease in the diagnostic performance of SPECT myocardial perfusion imaging (MPI) in patients with known or suspected coronary artery disease (CAD). METHODS: The study group comprised 41 patients (123 vessels) with known or suspected CAD prospectively recruited for systematic prone and supine 201Tl stress SPECT MPI. The diagnostic performance of SPECT MPI was determined for various image sets including nongated supine images (supine NG), nongated combined prone and supine images (prone and supine NG) and gated supine images, allowing WT evaluation from NG images in addition to perfusion (supine NG + WT) using invasive coronary angiography and fractional flow reserve as the gold standards. RESULTS: The rate of false positives was significantly higher among the supine NG images (20.8%) than among either the prone and supine NG or the supine NG + WT images (3.3% and 2.7%, respectively, P < 0.05 vs. supine NG). Consequently, specificity was higher for the prone and supine NG images than for the supine NG images (96.1% vs. 76.1%, P < 0.01) and was highest for the supine NG + WT images (96.8%, P not significant vs. prone and supine NG), without significant differences in sensitivity (80.0%, 86.6% and 73.3%, respectively, P not significant for all comparisons). CONCLUSION: The diagnostic performance of supine stress SPECT MPI is improved when WT assessment of ischaemic segments is used as an additional diagnostic criterion to values not significantly different from those with combined prone and supine acquisitions.
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