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

AbstractBACKGROUND:
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 > or = 50 and > or = 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 > or =50 and > or = 70% stenosis was 88 and 78%, respectively. The sensitivity for detection of patients with > or = 50 and > or = 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 > or = 50 and > or = 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.
AuthorsReginald G E J Groutars, J Fred Verzijlbergen, Monique M C Tiel-van Buul, Aeilco H Zwinderman, Carl A P L Ascoop, Norbert M van Hemel, Ernst E van der Wall
JournalThe international journal of cardiovascular imaging (Int J Cardiovasc Imaging) Vol. 19 Issue 3 Pg. 229-38 (Jun 2003) ISSN: 1569-5794 [Print] United States
PMID12834160 (Publication Type: Comparative Study, Evaluation Study, Journal Article)
Chemical References
  • Organophosphorus Compounds
  • Organotechnetium Compounds
  • Radiopharmaceuticals
  • Vasodilator Agents
  • technetium tc-99m tetrofosmin
  • Adenosine
Topics
  • Adenosine
  • Adult
  • Aged
  • Aged, 80 and over
  • Cardiomyopathies (diagnosis, epidemiology, physiopathology)
  • Coronary Angiography
  • Coronary Artery Disease (diagnosis, epidemiology, physiopathology)
  • Echocardiography
  • Exercise Test
  • False Positive Reactions
  • Female
  • Humans
  • Male
  • Middle Aged
  • Organophosphorus Compounds
  • Organotechnetium Compounds
  • Predictive Value of Tests
  • Prevalence
  • Radiopharmaceuticals
  • Risk Factors
  • Sensitivity and Specificity
  • Statistics as Topic
  • Stroke Volume (physiology)
  • Tomography, Emission-Computed, Single-Photon
  • Vasodilator Agents

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