title: Interpretive reproducibility of stress Tc-99m sestamibi tomographic myocardial perfusion imaging.
abstract: BACKGROUND
  Observer variability has been shown with interpretation of planar thallium-201 images. The interpretive reproducibility of technetium-99m sestamibi tomographic imaging is unknown. This study evaluated the interpretive reproducibility of interpretable Tc-99m sestamibi tomographic images among nuclear cardiologists with a wide range of training and experience.
  
  
  METHODS
  Three experienced readers (EX) and 3 less-experienced readers (LEX) interpreted 138 exercise and rest Tc-99m sestamibi tomographic images (101 were abnormal in patients with coronary artery disease [CAD], 37 were normal in patients with <5% likelihood of CAD) twice in random sequence without clinical data. Images of good to excellent quality were randomly selected from a database at 2 nuclear cardiology laboratories. Intraobserver and interobserver agreement for global, left anterior descending (LAD) territory, non-LAD first (normal/abnormal) and second (normal/fixed/reversible) order, and defect extent (normal/single-vessel CAD/multi-vessel CAD) were assessed with percent agreement and Cohen's kappa (kappa) statistic.
  
  
  RESULTS
  With regard to intraobserver agreement, first and second order ranged from 87% to 94% and 80% to 90% for global, 82% to 96% and 78% to 95% for LAD, and 88% to 91% and 80% to 90% for non-LAD, respectively. Defect extent ranged from 75% to 90%. There were no differences between EX and LEX for global and non-LAD first and second order, LAD first order, and defect extent. LAD second order was 93% for EX compared with 88% (P = .015) for LEX. With regard to interobserver agreement, first and second order ranged from 73% to 89% and 64% to 85% for global, 73% to 93% and 69% to 91% for LAD, and 76% to 88% and 68% to 84% for non-LAD, respectively. Defect extent ranged from 61% to 82%. Global first and second order ranged from 85% to 87% and 78% to 82% for EX compared with 73% to 84% and 64% to 79% for LEX. LAD first and second order ranged from 89% to 91% and 88% to 89% for EX compared with 73% to 91% and 69% to 70% for LEX. Non-LAD first and second order ranged from 82% to 86% and 76% to 77% for EX compared with 76% to 86% and 68% to 81% for LEX. Defect extent ranged from 69% to 75% for EX compared with 59% to 77% for LEX.
  
  
  CONCLUSIONS
  There is moderate to excellent interpretive reproducibility with stress Tc-99m sestamibi SPECT imaging among nuclear cardiologists with a wide range of training and experience.
authors.affiliation: Division of Cardiology, Roger Williams Medical Center, Brown University School of Medicine, Providence, RI, USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: Golub
authors.forename: A W
authors.initials: AW
authors.lastname: Ahlberg
authors.forename: J R
authors.initials: JR
authors.lastname: McClellan
authors.forename: S D
authors.initials: SD
authors.lastname: Herman
authors.forename: M I
authors.initials: MI
authors.lastname: Travin
authors.forename: J F
authors.initials: JF
authors.lastname: Mather
authors.forename: P W
authors.initials: PW
authors.lastname: Aitken
authors.forename: J I
authors.initials: JI
authors.lastname: Baron
authors.forename: G V
authors.initials: GV
authors.lastname: Heller
mesh_terms: D003326:Coronary Circulation; D003327:Coronary Disease / Q000000981:diagnostic imaging*; D003627:Data Interpretation, Statistical; D005080:Exercise Test; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D015588:Observer Variation; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon / Q000706:statistics & numerical data*
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi