Postexercise lung uptake of 99mTc-sestamibi determined by a new automatic technique: validation and application in detection of severe and extensive coronary artery disease and reduced left ventricular function.
This study validated a new automatic algorithm for assessment of lung-to-heart ratio (L/H) of radiotracers in myocardial perfusion SPECT and assessed the diagnostic value of (99m)Tc-sestamibi L/H after exercise.


METHODS
The new technique extracts a left ventricular region of interest (ROI) from a summed anterior projection image and generates a lung ROI by reshaping and translating the left ventricular ROI. This algorithm was applied to 230 patients who underwent exercise (99m)Tc-sestamibi SPECT (gated SPECT, n = 88) with first-pass ventriculography. Normal values were established in 26 patients in whom the likelihood of coronary artery disease (CAD) was 5% or less. An abnormality threshold for detecting severe and extensive CAD was defined in a subgroup of 109 patients who underwent coronary angiography and was validated in a prospective group (n = 72).


RESULTS
The success rate of the automatic algorithm was 97%. Excellent correlation was found between automatic and manual L/H values (r = 0.95; P < 0.001). The mean L/H was higher in patients with a peak exercise ejection fraction (EF) less than 40% versus 40% or more (0.51 +/- 0.07 versus 0.43 +/- 0.05, P < 0.001) and in patients with a poststress EF less than 40% versus 40% or more (0.50 +/- 0.07 versus 0.44 +/- 0.06, P < 0.01). A threshold of L/H greater than 0.44 yielded a sensitivity and specificity of 63% and 81%, respectively, for identifying severe and extensive CAD in the prospective group and a sensitivity of 86% in identifying stenosis of 90% or more in the proximal left anterior descending artery.


CONCLUSIONS
The new automatic algorithm for assessing L/H correlated well with manually derived L/H for (99m)Tc-sestamibi as well as (201)TI SPECT. An increased postexercise (99m)Tc-sestamibi L/H adds significant diagnostic value to study myocardial perfusion SPECT as a marker of severe and extensive CAD and reduced ventricular function.
Department of Imaging, Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
C
C
Bacher-Stier
T
T
Sharir
P B
PB
Kavanagh
H C
HC
Lewin
J D
JD
Friedman
R
R
Miranda
G
G
Germano
D S
DS
Berman
D000368:Aged; D000465:Algorithms; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005080:Exercise Test; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D019275:Radiopharmaceuticals; D013318:Stroke Volume; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging*; D015646:Ventriculography, First-Pass
D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi