title: Preliminary evaluation of a fuzzy logic-based automatic quantitative analysis in myocardial SPECT.
abstract: This study validates a new quantitative myocardial perfusion SPECT software.
  
  
  METHODS
  The processing starts with the extraction of the morphologic skeleton of the left ventricular myocardium from reconstructed transverse sections. Fuzzy logic is used to decide whether a pixel belongs to the myocardium and any perfusion defect is filled according to a truncated bullet model. The resulting image is partitioned in 18 isovolumetric sectors. Sex-matched normal limits, criteria of abnormality for rest (201)Tl and (99m)Tc-labeled perfusion tracers, reproducibility studies, and detection of coronary artery disease were developed and validated in an overall population of 343 patients. The sex- and tracer-matched means and SDs of a normal response were calculated in 93 male and 93 female patients with a <5% likelihood of coronary artery disease. Reproducibility measurements and assignment of different sectors of the myocardium to a specific coronary were performed from data collected in 49 and 60 patients, respectively. The accuracy of the detection of a coronary artery occlusion was assessed in 48 patients who also underwent coronary angiography.
  
  
  RESULTS
  The intra- and interoperator reproducibility of the sectorial activity was high with a linear regression coefficient of 0.97 and a SD of the difference measurement at 4.4% and 3.8%, respectively. Overall sensitivity and specificity for the detection of occluded coronary artery were 90% and 80%, respectively. For the detection of left anterior descending, left circumflex, and right artery coronary occlusion, sensitivity was 92%, 75%, and 92.5%, respectively, and specificity was 75%, 78%, and 90%, respectively.
  
  
  CONCLUSIONS
  The new quantitative myocardial perfusion SPECT software appears to be a very helpful program for the objective analysis of perfusion tracer distribution in myocardial SPECT and a very accurate tool in the detection and localization of coronary artery occlusion.
authors.affiliation: Division of Nuclear Medicine, Jean Perrin Cancer Center, Clermont-Ferrand, France.
authors.forename: Florent
authors.initials: F
authors.lastname: Cachin
authors.forename: Janusz
authors.initials: J
authors.lastname: Lipiecki
authors.forename: Danièle
authors.initials: D
authors.lastname: Mestas
authors.forename: Aimé
authors.initials: A
authors.lastname: Amonchot
authors.forename: Benjamin
authors.initials: B
authors.lastname: Geissler
authors.forename: Cyril
authors.initials: C
authors.lastname: Thouly
authors.forename: Jean
authors.initials: J
authors.lastname: Ponsonnaille
authors.forename: Jean
authors.initials: J
authors.lastname: Maublant
mesh_terms: D000465:Algorithms; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging*; D005240:Feasibility Studies; D005260:Female; D017143:Fuzzy Logic; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008297:Male; D010865:Pilot Projects; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012984:Software; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D014584:User-Computer Interface; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology