title: Clinical validation of automatic quantitative defect size in rest technetium-99m-sestamibi myocardial perfusion SPECT.
abstract: We examined the relationships of automatic quantitative perfusion defect size and defect severity to rest left ventricular ejection fraction and semiquantitative visual sestamibi defect size in rest 99mTc-sestamibi SPECT in 40 consecutive patients with a history of myocardial infarction more than 30 days prior to testing. The purpose of this investigation was to validate the use of automatic quantitative rest sestamibi SPECT as a clinical measure of assessing relative infarction size.
  
  
  METHODS
  All patients received 20-30 mCi of 99mTc-sestamibi followed by SPECT imaging. Quantitative defect analysis used previously developed resting normal limits and an automatic version of a commercially available quantitative program (CEqual). Semiquantitative visual defect interpretation used a 20 segment/scan and five-point scoring analysis. First-pass (FP) radionuclide ventriculography (RVG) and gated sestamibi perfusion SPECT were each performed in 31 patients.
  
  
  RESULTS
  LVEF assessed by FP RVG was 37% +/- 15% (range 14%-62%) and 37% +/- 16% (range 12%-63%) by gated perfusion SPECT with high linear correlation (r = 0.96, n = 22) between the two methods. Myocardial perfusion defect size was 24% +/- 15% of LV (range 0%-50%) and defect severity was 1103 +/- 864 (range 0 to 2825) by automatic quantitative rest sestamibi. Perfusion defect size and defect severity both had close correlations with LVEF by FP RVG (r = -0.78, r = -0.86) and by gated perfusion SPECT (r = -0.75, r = -0.79). High linear correlations were observed between quantitative defect size and summed visual score of segments with score > or = 2 (r = 0.82) and the number of visually abnormal segments (r = 0.77), as well as between defect severity and visual summed rest score (r = 0.86) and the number of visually abnormal segments (r = 0.76).
  
  
  CONCLUSIONS
  Quantitation of rest sestamibi SPECT defect extent and severity using automatic CEqual correlates well with rest LVEF and with semiquantitative expert visual analysis. Results of this study define a strong relationship between measurements of 99mTc-sestamibi perfusion defect as measured by an automatic software program and global left ventricular function. The automatic quantitative program appears to be a useful measure of assessing infarct size in patients with remote myocardial infarction.
authors.affiliation: Department of Imaging, Cedars-Sinai Medical Center, The CSMC Burns & Allen Research Institute, Los Angeles, California 90048, USA.
authors.forename: X
authors.initials: X
authors.lastname: Kang
authors.forename: D S
authors.initials: DS
authors.lastname: Berman
authors.forename: K F
authors.initials: KF
authors.lastname: Van Train
authors.forename: A M
authors.initials: AM
authors.lastname: Amanullah
authors.forename: J
authors.initials: J
authors.lastname: Areeda
authors.forename: J D
authors.initials: JD
authors.lastname: Friedman
authors.forename: H
authors.initials: H
authors.lastname: Kiat
authors.forename: G
authors.initials: G
authors.lastname: Germano
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003326:Coronary Circulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000503:physiopathology; D012146:Rest; D013318:Stroke Volume; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon; D015646:Ventriculography, First-Pass
chemical_list: D017256:Technetium Tc 99m Sestamibi