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European Journal of Nuclear Medicine and Molecular Imaging
Published in: European Journal of Nuclear Medicine and Molecular Imaging 7/2018

Open Access 01-07-2018 | Original Article

Automated SPECT analysis compared with expert visual scoring for the detection of FFR-defined coronary artery disease

Authors: R. S. Driessen, P. G. Raijmakers, I. Danad, W. J. Stuijfzand, S. P. Schumacher, J.A. Leipsic, J. K. Min, J. Knuuti, A. A. Lammertsma, A. C. van Rossum, N. van Royen, S. R. Underwood, P. Knaapen

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 7/2018

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Abstract

Purpose

Traditionally, interpretation of myocardial perfusion imaging (MPI) is based on visual assessment. Computer-based automated analysis might be a simple alternative obviating the need for extensive reading experience. Therefore, the aim of the present study was to compare the diagnostic performance of automated analysis with that of expert visual reading for the detection of obstructive coronary artery disease (CAD).

Methods

206 Patients (64% men, age 58.2 ± 8.7 years) with suspected CAD were included prospectively. All patients underwent 99mTc-tetrofosmin single-photon emission computed tomography (SPECT) and invasive coronary angiography with fractional flow reserve (FFR) measurements. Non-corrected (NC) and attenuation-corrected (AC) SPECT images were analyzed both visually as well as automatically by commercially available SPECT software. Automated analysis comprised a segmental summed stress score (SSS), summed difference score (SDS), stress total perfusion deficit (S-TPD), and ischemic total perfusion deficit (I-TPD), representing the extent and severity of hypoperfused myocardium. Subsequently, software was optimized with an institutional normal database and thresholds. Diagnostic performances of automated and visual analysis were compared taking FFR as a reference.

Results

Sensitivity did not differ significantly between visual reading and most automated scoring parameters, except for SDS, which was significantly higher than visual assessment (p < 0.001). Specificity, however, was significantly higher for visual reading than for any of the automated scores (p < 0.001 for all). Diagnostic accuracy was significantly higher for visual scoring (77.2%) than for all NC images scores (p < 0.05), but not compared with SSS AC and S-TPD AC (69.8% and 71.2%, p = 0.063 and p = 0.134). After optimization of the automated software, diagnostic accuracies were similar for visual (73.8%) and automated analysis. Among the automated parameters, S-TPD AC showed the highest accuracy (73.5%).

Conclusion

Automated analysis of myocardial perfusion SPECT can be as accurate as visual interpretation by an expert reader in detecting significant CAD defined by FFR.
Appendix
Available only for authorised users
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Metadata
Title
Automated SPECT analysis compared with expert visual scoring for the detection of FFR-defined coronary artery disease
Authors
R. S. Driessen
P. G. Raijmakers
I. Danad
W. J. Stuijfzand
S. P. Schumacher
J.A. Leipsic
J. K. Min
J. Knuuti
A. A. Lammertsma
A. C. van Rossum
N. van Royen
S. R. Underwood
P. Knaapen
Publication date
01-07-2018
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Nuclear Medicine and Molecular Imaging / Issue 7/2018
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-018-3951-1

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