title: Automatic detection and size quantification of infarcts by myocardial perfusion SPECT: clinical validation by delayed-enhancement MRI.
abstract: We aimed to validate the accuracy of a new automated myocardial perfusion SPECT quantification based on normal limits for detection and sizing of infarcts, using delayed-enhancement MRI (DE-MRI) as a gold standard.
  
  
  METHODS
  Eighty-two immediate (201)Tl rest scans and 26 (201)Tl delayed redistribution scans were compared with resting DE-MRI scans acquired within 24 h of SPECT acquisition. The immediate (201)Tl scans were considered for validation of infarct detection and the delayed (201)Tl scans were considered for infarct sizing. A simplified quantification scheme was used in which defect extent (EXT) and total perfusion deficit (TPD) parameters were derived automatically from SPECT images by comparison with sex-matched normal limits and applying a 3.0 average deviation criterion. The total extent of hyperenhancement expressed as the percentage of the left ventricle was derived from DE-MRI images by visual definition of myocardial contours and defects. DE-MRI and SPECT images were fused in 3 dimensions for visual comparison. Phantom data were also quantified using the same EXT and TPD measures for defects ranging from 5% to 70% of the myocardium.
  
  
  RESULTS
  The area under the receiver-operator-characteristic curve for the detection of infarct on immediate rest scans was 0.91 +/- 0.03 for EXT and 0.90 +/- 0.03 for TPD (P = not significant). The sensitivity and specificity for the detection of infarct by EXT on immediate (201)Tl rest scan were 87% and 91%, respectively, with the optimal defect size threshold of 4%. Six of 7 cases with DE-MRI defects < 5% were detected by SPECT. Infarct sizes obtained from DE-MRI correlated well with EXT (slope = 0.94, offset = 3.8%; r = 0.84) and TPD (slope = 0.75, offset = 4.2%; r = 0.85) obtained from delayed SPECT (201)Tl scans. Excellent correlation was observed between the SPECT quantification and the physical defect size for the phantom data. The actual size of the defect was better estimated by EXT (slope = 1.00, offset 1.33%; r = 0.99) than by TPD (slope = 0.79, offset = 1.9%; r = 0.99).
  
  
  CONCLUSIONS
  Automated quantification of the EXT on myocardial perfusion SPECT images can reliably detect infarcts and measure infarct sizes.
authors.affiliation: Artificial Intelligence in Medicine Program, Departments of Imaging and Medicine, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA. Piotr.Slomka@cshs.org
authors.forename: Piotr J
authors.initials: PJ
authors.lastname: Slomka
authors.forename: David
authors.initials: D
authors.lastname: Fieno
authors.forename: Louise
authors.initials: L
authors.lastname: Thomson
authors.forename: John D
authors.initials: JD
authors.lastname: Friedman
authors.forename: Sean W
authors.initials: SW
authors.lastname: Hayes
authors.forename: Guido
authors.initials: G
authors.lastname: Germano
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Berman
mesh_terms: D000368:Aged; D000465:Algorithms; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis*; D010363:Pattern Recognition, Automated / Q000379:methods; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013382:Subtraction Technique; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*