title: Encircling reperfusion pattern on the stress-minus-delay bull's-eye map improves sensitivity of myocardial perfusion scans.
abstract: BACKGROUND
  Myocardial perfusion imaging is subject to considerable noise due to re-registration and attenuation artifact.
  
  
  METHODS
  On a retrospective review, we identified 51 studies that showed encircling reperfusion pattern on a stress-minus-delay bull's-eye map with concurrent cardiac catheterization within 4 months. Encircling reperfusion was defined as a band of reversibility > or =2.5 standard deviations above that of the gender-matched and age-matched normal studies. This had to surround the delay defect for at least two-thirds of its circumference on the stress-minus-delay bull's-eye map. Three expert readers, blinded to cardiac catheterization results, individually interpreted myocardial perfusion imaging without and with a stress-minus-delay bull's-eye map. A certainty index of 1-100 (100 being the highest certainty for the presence of perfusion defects) was recorded for image interpretation.
  
  
  RESULTS
  The intra-class correlation coefficient between readers indicated a strong agreement. Using encircling reperfusion pattern on a stress-minus-delay bull's-eye map, the mean increase in certainty index scores was 8.0+/-7.30 (P<0.0001). This increase in certainty index scores was associated with a significant increase in sensitivity from 67 to 83% (P=0.01) without any significant decrease in specificity (P=0.16).
  
  
  CONCLUSIONS
  The pattern of encircling reperfusion on the stress-minus-delay bull's-eye map can improve the interpreter's confidence and sensitivity without significantly compromising specificity for identifying true myocardial perfusion defects.
authors: Department of Medicine and Radiology, Medical College of Georgia and Veterans Affair Medical Center, Augusta, GA 30912, USA. vrobinso@mail.mcg.edu
authors: Vincent J B
authors: VJ
authors: Robinson
authors: Rakesh N
authors: RN
authors: Patel
authors: Venkata R P
authors: VR
authors: Nalamolu
authors: Robert J
authors: RJ
authors: Kaminski
authors: James K
authors: JK
authors: Dias
authors: John W
authors: JW
authors: Thornton
authors: Terry W
authors: TW
authors: Kersey
authors: Mahendra K
authors: MK
authors: Mandawat
mesh_terms: D016477:Artifacts; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging*; D005080:Exercise Test; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D015588:Observer Variation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology