title: A multicenter trial on interobserver and intraobserver reproducibility of segmental scoring of thallium-201 planar myocardial imaging before and after reinjection. Italian Group of Nuclear Cardiology.
abstract: Inter- and intraobserver reproducibility (R) of segmental 201Tl scores after stress (ST), redistribution (RD) and reinjection (RI) planar imaging were evaluated.
  
  
  METHODS
  Images were examined from 396 patients with suspected coronary artery disease, demonstrated by means of post-ST imaging of at least one perfusion defect. To eliminate external sources of variability, the same gamma camera, acquisition protocol and computer software were used in this multicenter study. Thallium-201 images of the anterior, left anterior oblique and left lateral projections were obtained immediately, 4 hr after exercise and 30 min after the injection of additional 201Tl either on the same day or on a different day. The left ventricle was divided into 15 segments and evaluated by three independent observers, blinded to clinical data, according to a five-point scale.
  
  
  RESULTS
  The R score for ST, RD and RI images, expressed as an intraclass correlation coefficient, was 0.76, 0.74 and 0.72, respectively. After averaging multiple observer scores, R increased to 0.91, 0.90 and 0.89, respectively. Individual observer measurement of the R score was 0.48, 0.51 and 0.32 for ST-RD, ST-RI and RD-RI image pairs, respectively, and multiple observer scores showed R increases to 0.74, 0.76 and 0.58.
  
  
  CONCLUSIONS
  This qualitative scale reliably assesses the severity of 201Tl perfusion defects, particularly when multiple-observer scores are averaged. Individual observer change scores should be taken with great caution, especially in studies involving the visual evaluation of RD-RI image changes.
authors.affiliation: Department of Nuclear Medicine, Ospedale Maggiore, Novara, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Brambilla
authors.forename: E
authors.initials: E
authors.lastname: Inglese
authors.forename: G
authors.initials: G
authors.lastname: Cannizzaro
authors.forename: M
authors.initials: M
authors.lastname: Dondi
authors.forename: R
authors.initials: R
authors.lastname: Sara
authors.forename: F
authors.initials: F
authors.lastname: Arrigo
authors.forename: G L
authors.initials: GL
authors.lastname: Tarolo
mesh_terms: D003327:Coronary Disease / Q000000981:diagnostic imaging; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011877:Radionuclide Imaging; D015203:Reproducibility of Results; D013794:Thallium Radioisotopes / Q000008:administration & dosage
chemical_list: D013794:Thallium Radioisotopes