Technetium-99m-pyrophosphate scintigraphy in patients with suspected acute myocardial infarction: impact of interobserver variability.
Technetium-99m-pyrophosphate (TcPYP) scintigraphy may have great value in patients with suspected acute myocardial infarction (AMI), but interobserver variability undoubtedly has adverse impact on predictive value. TcPYP scintigrams for 133 (80%) of 166 consecutive patients admitted for suspected AMI were interpreted independently by three experienced readers. Although there was complete agreement for 87 interpretations (65%), major discrepancies (i.e., at least one positive and one negative reading on the same scan) occurred for 28 scans (21%). To assess predictive accuracy, patients were categorized as follows: 36 had definite AMI manifest by new ECG Q waves and/or CK-MB evidence of AMI (group I), 56 were classified as possible AMI (group II), and 41 had AMI excluded (group III). Using only the definitive diagnostic categories (groups I and III), accuracy for each reader approximated 0.68, with no single reader being correct more often than any other.
Fisher
M L
ML
Kelemen
M H
MH
Collins
D
D
Holder
L
L
Winzelberg
G
G
Plotnick
G D
GD
Morris
F
F
Moran
G W
GW
Carliner
N H
NH
Peters
R W
RW
D003402:Creatine Kinase / Q000097:blood; D003951:Diagnostic Errors; D011756:Diphosphates; D004562:Electrocardiography; D006801:Humans; D007527:Isoenzymes; D009203:Myocardial Infarction / Q000175:diagnosis / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D011877:Radionuclide Imaging; D013667:Technetium; D016698:Technetium Tc 99m Pyrophosphate
D011756:Diphosphates; D007527:Isoenzymes; D016698:Technetium Tc 99m Pyrophosphate; D013667:Technetium; D003402:Creatine Kinase