title: Improved quantification and normal limits for myocardial perfusion stress-rest change.
abstract: We aimed to improve the quantification of myocardial perfusion stress-rest changes in myocardial perfusion SPECT (MPS) studies for the optimal automatic detection of ischemia and coronary artery disease (CAD).
  
  
  METHODS
  Rest-stress (99m)Tc MPS studies (997 cases; 651 consecutive cases with correlating angiography and 346 cases with less than 5% likelihood (low likelihood [LLK]) of CAD) were analyzed. Normal limits for stress-rest changes were derived from additional LLK patients (40 women, 40 men). We computed the global stress-rest change (C-SR) by integrating direct stress-rest changes for each polar map pixel. Additionally, stress-rest change and total perfusion deficit (TPD) at stress were combined in 1 variable (C-TPD) for the optimal detection of CAD.
  
  
  RESULTS
  The area under the receiver-operating-characteristic curve (AUC) for C-SR (0.92) was larger than that for stress TPD-rest TPD (0.88) for the identification of stenosis of 70% or more (P < 0.0001). AUC (0.94) and sensitivity (90%) for C-TPD were higher than those for stress TPD (0.91 and 83%, respectively) (P < 0.0001), whereas specificity remained the same (81%).
  
  
  CONCLUSIONS
  C-SR and C-TPD provide higher diagnostic performance than difference between stress and rest TPD or stress hypoperfusion analysis.
authors.affiliation: Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California, USA.
authors.forename: Mithun
authors.initials: M
authors.lastname: Prasad
authors.forename: Piotr J
authors.initials: PJ
authors.lastname: Slomka
authors.forename: Mathews
authors.initials: M
authors.lastname: Fish
authors.forename: Paul
authors.initials: P
authors.lastname: Kavanagh
authors.forename: James
authors.initials: J
authors.lastname: Gerlach
authors.forename: Sean
authors.initials: S
authors.lastname: Hayes
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Berman
authors.forename: Guido
authors.initials: G
authors.lastname: Germano
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D005080:Exercise Test / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000706:statistics & numerical data*; D019275:Radiopharmaceuticals; D012016:Reference Values; D012189:Retrospective Studies; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon / Q000706:statistics & numerical data*
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi