title: Technetium-99m-pyrophosphate scintigraphy in patients with suspected acute myocardial infarction: impact of interobserver variability.
abstract: 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.
authors.forename: M L
authors.initials: ML
authors.lastname: Fisher
authors.forename: M H
authors.initials: MH
authors.lastname: Kelemen
authors.forename: D
authors.initials: D
authors.lastname: Collins
authors.forename: L
authors.initials: L
authors.lastname: Holder
authors.forename: G
authors.initials: G
authors.lastname: Winzelberg
authors.forename: G D
authors.initials: GD
authors.lastname: Plotnick
authors.forename: F
authors.initials: F
authors.lastname: Morris
authors.forename: G W
authors.initials: GW
authors.lastname: Moran
authors.forename: N H
authors.initials: NH
authors.lastname: Carliner
authors.forename: R W
authors.initials: RW
authors.lastname: Peters
mesh_terms: 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
chemical_list: D011756:Diphosphates; D007527:Isoenzymes; D016698:Technetium Tc 99m Pyrophosphate; D013667:Technetium; D003402:Creatine Kinase