title: Combined quantitative analysis of attenuation corrected and non-corrected myocardial perfusion SPECT: Method development and clinical validation.
abstract: BACKGROUND
  Attenuation corrected myocardial perfusion SPECT (AC-MPS) has been demonstrated to improve the specificity of detecting coronary artery disease (CAD) by visual analysis which utilizes both non-corrected (NC) and AC data. However, the combined automated quantification of NC and AC-MPS has not been previously described. We aimed to develop a combined quantitative analysis from AC and NC data to improve the accuracy of automated detection of CAD from AC-MPS.
  
  
  METHODS
  Stress total perfusion deficit (TPD) values were generated by standard analysis for NC (NC-TPD), AC (AC-TPD) and by combined NC-AC analysis (NA-TPD), in which the hypoperfusion severity in each polar map location was defined as the average of AC and NC severity computed by comparison with separate AC and NC normal limits. Ischemic TPD was also calculated as the difference between stress TPD and rest TPD for each measure. Stress/rest Tc-99m sestamibi MPS studies in 650 patients with correlating coronary angiography and in 345 patients with a low-likelihood (LLk) of CAD were used to assess diagnostic performance of combined NC-AC analysis.
  
  
  RESULTS
  NA-TPD had a higher receiver-operator-characteristic area under the curve (ROC-AUC) (0.87) than NC-TPD (0.85; P < .01) or AC-TPD (0.85; P < .01) for detection of stenosis >or=70% in angiographic group. It also had higher specificity (75%) vs NC-TPD (65%; P < .0001), or AC-TPD (70%; P = .016). In LLk group, the normalcy rate of NA-TPD (95%) was higher than for NC-TPD (90%; P < .01) and similar to AC-TPD (94%; P = NS). NA-TPD had higher ROC-AUC than that for 17-segment expert visual scoring of stress scans in angiographic group (0.84; P = .01), comparable accuracy (81%) and similar normalcy rates (95% vs 97%; P = NS). Ischemic TPD by combined NC-AC analysis had higher ROC-AUC than that for any ischemic measure. Similar to stress NA-TPD, it also obtained the similar performance results as compared with ischemic TPD based on NC or AC and higher sensitivity (89% vs 85%; P = .0295) as compared with ischemic visual score in angiographic group.
  
  
  CONCLUSIONS
  Combined NC-AC MPS quantification using either stress or ischemic TPD shows significant improvements for ROC-AUC and specificity of MPS in the detection of CAD compared with standard NC-MPS or AC-MPS and comparable performance to expert visual scoring. This technique may lead to an enhancement in a fully automated quantification for the perfusion analysis by AC-MPS.
authors.affiliation: Department of Imaging, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Taper #A047, Los Angeles, CA 90048, USA. yuan.xu@cshs.org
authors.forename: Yuan
authors.initials: Y
authors.lastname: Xu
authors.forename: Mathews
authors.initials: M
authors.lastname: Fish
authors.forename: James
authors.initials: J
authors.lastname: Gerlach
authors.forename: Mark
authors.initials: M
authors.lastname: Lemley
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Berman
authors.forename: Guido
authors.initials: G
authors.lastname: Germano
authors.forename: Piotr J
authors.initials: PJ
authors.lastname: Slomka
mesh_terms: D016477:Artifacts; D003324:Coronary Artery Disease / Q000175:diagnosis*; D005080:Exercise Test; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013382:Subtraction Technique; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
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