Diagnostic accuracy of gated Tc-99m sestamibi stress myocardial perfusion SPECT with combined supine and prone acquisitions to detect coronary artery disease in obese and nonobese patients.
BACKGROUND
The diagnostic value of gated myocardial perfusion single-photon emission computed tomography (MPS) with combined supine and prone acquisitions to detect coronary artery disease (CAD) in obese and nonobese patients has not been defined.


RESULTS
We studied 1511 patients without prior myocardial infarction or coronary revascularization who either had coronary angiography within 3 months of MPS (n = 785) or had a low pretest likelihood of CAD (n = 726). All patients underwent rest thallium 201/gated exercise or adenosine stress technetium 99m sestamibi MPS in both the supine and prone positions. According to body mass index (BMI), patients were categorized as normal weight (BMI of 18.5-24.9 kg/m2), overweight (BMI of 25.0-29.9 kg/m2), or obese (BMI > or = 30.0 kg/m2). There were no significant differences in stress, fixed, or ischemic defects among patients in different weight categories. The sensitivity of MPS was 85%, 86%, and 89% for detecting patients with 50% or greater coronary stenosis and 89%, 91%, and 92% for detecting those with 70% or greater coronary stenosis in the normal-weight, overweight, and obese groups, respectively. Normalcy rates were nearly identical among the 3 weight groups (99%, 98%, and 99%, respectively). Multivariate logistic regression analysis further confirmed that BMI was a nonsignificant predictor for the detection of CAD. In a subset of 290 patients, automated quantitative MPS analysis confirmed that combined supine and prone MPS increased specificity (86%) in identifying CAD, without a significant reduction in sensitivity (83% for > or = 50% stenosis and 88% for > or = 70% stenosis).


CONCLUSIONS
The findings of this study suggest that MPS performed with gating and combined supine and prone acquisitions without attenuation correction had a similar diagnostic accuracy for the detection of CAD in normal-weight, overweight, and obese patients.
Berman
Daniel S
DS
Department of Imaging, Division of Nuclear Medicine, Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif 90048, USA. bermand@cshs.org
Kang
Xingping
X
Nishina
Hidetaka
H
Slomka
Piotr J
PJ
Shaw
Leslee J
LJ
Hayes
Sean W
SW
Cohen
Ishac
I
Friedman
John D
JD
Gerlach
James
J
Germano
Guido
G
D000368:Aged; D016477:Artifacts; D049628:Body Size; D002140:California / Q000453:epidemiology; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D005080:Exercise Test / Q000706:statistics & numerical data; D015637:Gated Blood-Pool Imaging / Q000706:statistics & numerical data*; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D009765:Obesity / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D011187:Posture; D011379:Prognosis; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon / Q000706:statistics & numerical data*
D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi